JAIME PAULA PESSOA LINHARES FILHO
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- Long-term prognostic value of late gadolinium enhancement and periprocedural myocardial infarction after uncomplicated revascularization: MASS-V follow-up(2022) LINHARES-FILHO, Jaime; HUEB, Whady; LIMA, Eduardo; REZENDE, Paulo; AZEVEDO, Diogo; ROCHITTE, Carlos; NOMURA, Cesar; SERRANO-JUNIOR, Carlos; RAMIRES, Jose; KALIL-FILHO, RobertoAims Cardiac biomarkers elevation is common after revascularization, even in absence of periprocedural myocardial infarction (PMI) detection by imaging methods. Thus, late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) may be useful on PMI diagnosis and prognosis. We sought to evaluate long-term prognostic value of PMI and new LGE after revascularization. Methods and results Two hundred and two patients with multivessel coronary disease and preserved ventricular function who underwent elective revascularization were included, of whom 136 (67.3%) underwent coronary artery bypass grafting and 66 (32.7%) percutaneous coronary intervention. The median follow-up was 5 years (4.8-5.8 years). Cardiac biomarkers measurement and LGE-CMR were performed before and after procedures. The Society for Cardiovascular Angiography and Interventions definition was used to assess PMI. Primary endpoint was composed of death, infarction, additional revascularization, or cardiac hospitalization. Primary endpoint was observed in 29 (14.3%) patients, of whom 13 (14.9%) had PMI and 16 (13.9%) did not (P = 0.93). Thirty-six (17.8%) patients had new LGE. Twenty (12.0%) events occurred in patients without new LGE and 9 (25.2%) in patients with it (P = 0.045). LGE was also associated to increased mortality, with 4 (2.4%) and 4 (11.1%) deaths in subjects without and with it (P = 0.02). LGE was the only independent predictor of primary endpoint and mortality (P = 0.03 and P = 0.02). Median LGE mass was estimated at 4.6 g. Patients with new LGE had a greater biomarkers release (median troponin: 8.9 ng/mL vs. 1.8 ng/mL and median creatine kinase-MB: 38.0 ng/mL vs. 12.3 ng/mL; P < 0.001 in both comparisons). Conclusions New LGE was shown to be better prognostic predictor than biomarker-only PMI definition after uncomplicated revascularization. Furthermore, new LGE was the only independent predictor of cardiovascular events and mortality.
- Effect of diabetic kidney disease on therapeutic strategies for coronary artery disease: ten year follow-up(2021) BATISTA, Daniel Valente; HUEB, Whady; LIMA, Eduardo Gomes; REZENDE, Paulo Cury; GARZILLO, Cibele Larrosa; GARCIA, Rosa Maria Rahmi; LINHARES FILHO, Jaime Paula Pessoa; MARTINS, Eduardo Bello; SERRANO JUNIOR, Carlos Vicente; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground: The best treatment for coronary artery disease (CAD) in patients with type 2 diabetes (DM2) and chronic kidney disease is unknown. Methods: This retrospective study included MASS registry patients with DM2 and multivessel CAD, stratified by kidney function. Primary endpoint was combined of mortality, myocardial infarction, or additional revascularization. Results: Median follow-up was 9.5 years. Primary endpoint occurrences among strata 1 and 2 were 53.4% and 40.7%, respectively (P=.020). Mortality rates were 37.4% and 24.6% in strata 1 and 2, respectively (P<.001). We observed a lower rate of major adverse cardiovascular events (MACE) (P=.027 for stratum 1 and P<.001 for stratum 2) and additional revascularization (P=.001 for stratum 1 and P<.001 for stratum 2) for those in the surgical group. In a multivariate analysis, eGFR was an independent predictor of MACE (P=.034) and mortality (P=.020). Conclusions: Among subjects with DM2 and CAD the presence of lower eGFR rate was associated with higher rates of MACE and mortality, irrespective of treatment choice. CABG was associated with lower rates of MACE in both renal function strata. eGFR was an independent predictor of MACE and mortality in a 10-year follow-up.
- Significant association of SYNTAX score on release of cardiac biomarkers in uncomplicated post-revascularization procedures among patients with stable multivessel disease MASS-V Study group(2020) AZEVEDO, Diogo Freitas Cardoso de; HUEB, Whady; LIMA, Eduardo Gomes; REZENDE, Paulo Cury; LINHARES FILHO, Jaime Paula Pessoa; CARVALHO, Guilherme Fernandes de; MARTINS, Eduardo Bello; NOMURA, Cesar Higa; STRUNZ, Celia Maria Cassaro; SERRANO JUNIOR, Carlos Vicente; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoThis study investigated the relationship between angiographic complexities of coronary artery disease (CAD) assessed by SYNTAX Score synergy between percutaneous coronary intervention with taxus and cardiac surgery score (SYNTAX Score) and cardiac biomarker elevation after revascularization procedures. This is a post-hoc analysis of the medicine, angioplasty or surgery study V study of patients with stable CAD. High-sensitivity troponin 1 (hs-TnI) and creatinine kinase-muscle/brain (CK-MB) were assessed before and after cardiovascular procedures. Baselines SYNTAX Scores (SXScores) were calculated by blinded investigators to patient characteristics. Of the 202 patients studied, the mean SXScore was 21.25 +/- 9.24; 40.10 +/- 7.09 in the high SXScore group and 19.06 +/- 6.61 in low/mid SXscore group (P < .0001). Positive correlations existed between SXScore and median peaks after procedural hs-TnI (r = 0.18, P = .009) and CK-MB (r = 0.24, P = .001) levels. In patients with high SXScores (>= 33), the median peaks of post-procedural hs-TnI (P = .034)and CK-MB (P = .004) levels were higher than in low/mid SXScore group (<33).The release of hs-TnI at 6 (P = .002), 12 (P = .008), and 24 hours (P = .039) was higher in high SXScore group than in low/mid SXscore group (<33) as was the release of CK-MB at 6 (P < .0001), 12 (P < .0001), 24 (P = .001), 36 (P = .007), 48 (P = .008), and 72 hours (P = .023). After multivariable analysis, high SXScore was a significant independent predictor of release of CK-MB and hs-TnI peaks higher than the median. The increase in release of cardiac biomarkers was significantly associated with the extent of atherosclerosis identified by the SYNTAX Score.
- 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.
- Long-term outcomes of patients with stable coronary disease and chronic kidney dysfunction: 10-year follow-up of the Medicine, Angioplasty, or Surgery Study II Trial(2020) LIMA, Eduardo Gomes; CHARYTAN, David M.; HUEB, Whady; AZEVEDO, Diogo Freitas Cardoso de; GARZILLO, Cibele Larrosa; FAVARATO, Desiderio; LINHARES FILHO, Jaime Paula Pessoa; MARTINS, Eduardo Bello; BATISTA, Daniel Valente; REZENDE, Paulo Cury; HUEB, Alexandre Ciappina; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground. Chronic kidney disease (CKD) is associated with a worse prognosis in patients with stable coronary artery disease (CAD); however, there is limited randomized data on long-term outcomes of CAD therapies in these patients. We evaluated long-term outcomes of CKD patients with CAD who underwent randomized therapy with medical treatment (MT) alone, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Methods. Baseline estimated glomerular filtration rate (eGFR) was obtained in 611 patients randomized to one of three therapeutic strategies in the Medicine, Angioplasty, or Surgery Study II trial. Patients were categorized in preserved renal function and mild or moderate CKD groups depending on their eGFR (>= 90, 89-60 and 59-30 mL/min/1.73 m(2), respectively). The primary clinical endpoint, a composite of overall death and myocardial infarction, and its individual components were analyzed using proportional hazards regression (Clinical Trial registration information: http://www.controlled-trials.com.Registration number: ISRCTN66068876). Results. Of 611 patients, 112 (18%) had preserved eGFR, 349 (57%) mild dysfunction and 150 (25%) moderate dysfunction. The primary endpoint occurred in 29.5, 32.4 and 44.7% (P = 0.02) for preserved eGFR, mild CKD and moderate CKD, respectively. Overall mortality incidence was 18.7, 23.8 and 39.3% for preserved eGFR, mild CKD and moderate CKD, respectively (P = 0.001). For preserved eGFR, there was no significant difference in outcomes between therapies. For mild CKD, the primary event rate was 29.4% for PCI, 29.1% for CABG and 41.1% for MT (P = 0.006) [adjusted hazard ratio (HR) = 0.26, 95% confidence interval (CI) 0.07-0.88; P = 0.03 for PCI versus MT; and adjusted HR = 0.48; 95% CI 0.31-0.76; P = 0.002 for CABG versus MT]. We also observed higher mortality rates in the MT group (28.6%) compared with PCI (24.1%) and CABG (19.0%) groups (P = 0.015) among mild CKD subjects (adjusted HR = 0.44, 95% CI 0.25-0.76; P = 0.003 for CABG versus MT; adjusted HR = 0.56, 95% CI 0.07-4.28; P = 0.58 for PCI versus MT). Results were similar with moderate CKD group but did not achieve significance. Conclusions. Coronary interventional therapy, both PCI and CABG, is associated with lower rates of events compared with MT in mild CKD patients >10 years of follow-up. More study is needed to confirm these benefits in moderate CKD.
- 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.
- Surgical and percutaneous revascularization outcomes based on SYNTAX I, II, and residual scores: a long-term follow-up study(2021) MARTINS, Eduardo Bello; HUEB, Whady; BROWN, David L.; SCUDELER, Thiago Luis; LIMA, Eduardo Gomes; REZENDE, Paulo Cury; SOARES, Paulo Rogerio; GARZILLO, Cibele Larrosa; LINHARES FILHO, Jaime Paula Pessoa; BATISTA, Daniel Valente; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoBackground The objective of this study was to evaluate the association of SYNTAX scores I, II, and residual with cardiovascular outcomes of patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) and compare both procedures in a long-term follow-up. Methods This is a retrospective single-center study from the MASS registry at the Heart Institute of the University of Sao Paulo, Brazil in which 969 patients with stable coronary artery disease undergoing CABG (559) or PCI (410) were included. We assessed the SYNTAX scores I, II and residual in both interventions. Clinical endpoints were the first occurrence of a composite of overall death, myocardial infarction, stroke, or repeat revascularization (MACCE) and the total occurrence of each component of MACCE. Results In the CABG sample, SSI had a median of 23 (IQR 17-29.5), median SSII of 25.4 (IQR 19.2-32.8), and median rSS of 2 (IQR 0-6.5); in PCI SSI had a median of 14 (IQR 10-19.1), median SSII of 28.7 (IQR 23-34.2), and median rSS of 4.7 (IQR 0-9). Total of 174 events were documented and CABG patients had a lower rate of MACCE (15.6% vs. 21.2%; adjusted HR 1.98; 95% CI 1.13-3.47; P = 0.016) and repeat revascularization (3.8% vs. 11.5%; adjusted HR 4.35; CI 95% 1.74-10.85; P = 0.002) compared with PCI. No SYNTAX score tertile found a difference in death rate between procedures. In a multivariate analysis, the rSS was an independent predictor for MACCE (HR 1.04; 95% CI 1.01-1.06; P = 0.001). Regarding death, the only independent predictors were ejection fraction and renal function. Conclusion Surgical revascularization resulted in a more complete revascularization and lower rates of major cardiac or cerebrovascular events in a long-term follow-up. Also, grading the incompleteness of revascularization through the residual SYNTAX score identified a higher event rate, suggesting that complete revascularization is associated with a better prognosis.
- Update on the Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline of the Brazilian Society of Cardiology-2019(2019) BERNOCHE, Claudia; TIMERMAN, Sergio; POLASTRI, Thatiane Facholi; GIANNETTI, Natali Schiavo; SIQUEIRA, Adailson Wagner da Silva; PISCOPO, Agnaldo; SOEIRO, Alexandre de Matos; REIS, Amelia Gorete Afonso da Costa; TANAKA, Ana Cristina Sayuri; THOMAZ, Ana Maria; QUILICI, Ana Paula; CATARINO, Andrei Hilario; RIBEIRO, Anna Christina de Lima; BARRETO, Antonio Carlos Pereira; AZEVEDO FILHO, Antonio Fernando Barros de; PAZIN FILHO, Antonio; TIMERMAN, Ari; SCARPA, Bruna Romanelli; TIMERMAN, Bruno; TAVARES, Caio de Assis Moura; MARTINS, Cantidio Soares Lemos; SERRANO JUNIOR, Carlos Vicente; MALAQUE, Ceila Maria Sant'Ana; PISANI, Cristiano Faria; BATISTA, Daniel Valente; LEANDRO, Daniela Luana Fernandes; SZPILMAN, David; GONCALVES, Diego Manoel; PAIVA, Edison Ferreira de; OSAWA, Eduardo Atsushi; LIMA, Eduardo Gomes; ADAM, Eduardo Leal; PEIXOTO, Elaine; EVARISTO, Eli Faria; AZEKA, Estela; SILVA, Fabio Bruno da; WEN, Fan Hui; FERREIRA, Fatima Gil; LIMA, Felipe Gallego; FERNANDES, Felipe Lourenco; GANEM, Fernando; GALAS, Filomena Regina Barbosa Gomes; TARASOUTCHI, Flavio; SOUZA, Germano Emilio Conceicao; FEITOSA FILHO, Gilson Soares; FORONDA, Gustavo; GUIMARAES, Helio Penna; ABUD, Isabela Cristina Kirnew; LEITE, Ivanhoe Stuart Lima; LINHARES FILHO, Jaime Paula Pessoa; MORAES JUNIOR, Joao Batista de Moura Xavier; FALCAO, Joao Luiz Alencar de Araripe; RAMIRES, Jose Antonio Franchini; CAVALINI, Jose Fernando; SARAIVA, Jose Francisco Kerr; ABRAO, Karen Cristine; PINTO, Lecio Figueira; BIANCHI, Leonardo Luis Torres; LOPES, Leonardo Nicolau Geisler Daud; PIEGAS, Leopoldo Soares; KOPEL, Liliane; GODOY, Lucas Colombo; TOBASE, Lucia; HAJJAR, Ludhmila Abrahao; DALLAN, Luis Augusto Palma; CANEO, Luiz Fernando; CARDOSO, Luiz Francisco; CANESIN, Manoel Fernandes; PARK, Marcelo; RABELO, Marcia Maria Noya; MALACHIAS, Marcus Vinicius Bolivar; GONCALVES, Maria Aparecida Batistao; ALMEIDA, Maria Fernanda Branco de; SOUZA, Maria Francilene Silva; FAVARATO, Maria Helena Sampaio; CARRION, Maria Julia Machline; GONZALEZ, Maria Margarita; BORTOLOTTO, Maria Rita de Figueiredo Lemos; MACATRAO-COSTA, Milena Frota; SHIMODA, Monica Satsuki; OLIVEIRA-JUNIOR, Mucio Tavares de; IKARI, Nana Miura; DUTRA, Oscar Pereira; BERWANGER, Otavio; PINHEIRO, Patricia Ana Paiva Correa; REIS, Patricia Feitosa Frota dos; CELLIA, Pedro Henrique Moraes; SANTOS FILHO, Raul Dias dos; GIANOTTO-OLIVEIRA, Renan; KALIL FILHO, Roberto; GUINSBURG, Ruth; MANAGINI, Sandrigo; LAGE, Silvia Helena Gelas; YEU, So Pei; FRANCHI, Sonia Meiken; SHIMODA-SAKANO, Tania; ACCORSI, Tarso Duenhas; LEAL, Tatiana de Carvalho Andreucci; GUIMARAES, Vanessa; SALLAI, Vanessa Santos; AVILA, Walkiria Samuel; SAKO, Yara Kimiko