Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UERJ |
Texto Completo: | http://www.bdtd.uerj.br/handle/1/20739 |
Resumo: | Ischemic heart disease is one of the most common causes of death worldwide. There are few data in the literature about the association of clinical profile and coronary angiography results in our population. From August 2015 to April 2018, 1 844 patients submitted to coronary angiography at Hospital Universitário Pedro Ernesto (HUPE) were enrolled in this cross-sectional study. They were evaluated by their clinical variables, angiographic results and procedure complications. Results: mean age 62,1±10,3 years, mean body mass index (BMI) 27,4±5,0 kg/m² and 26,3% were obese. Most of the population were outpatients (71,0%). Patients referred by HUPE were 15,5% of population. Stable angina was the most common indication (62,9%). Only 19,7% underwent noninvasive testing (NT). Arterial hypertension (AH) was the most prevalent RF (88,2%), followed by dyslipidemia (DLP) with 60,2%. Only 4,2% of population did not have any RF. Transradial approach was used in 91,7% of patients. Most patients (65%) had obstructive CAD (intermediate and severe stenosis) and 58,2% when considered only severe stenosis CAD. Mild and severe left main coronary artery (LM) disease was found in 8,1% of patients and 4,7% when considered only severe stenosis. AH, DLP, diabetes mellitus (DM), family history (FH) of CAD, smoking, peripheral artery disease (PAD) and chronic kidney disease (CKD) were associated with CAD (p<0,05) and worse angiographic results. DM and DLP were associated (p<0,05) with LM disease. Obesity and NT were not associated with CAD. The quantity of RF, male sex, older age group and patients referred by HUPE were considered independent risk predictors for CAD after multivariable analysis. LM disease independent risk predictors were male sex, older age group, non-insulin-dependent DM (NIDM) and DLP. Death occurred in 3 (0,16%) patients and acute coronary occlusion in 4 (0,2%). In conclusion: classic risk factors were associated with the presence of CAD. Older age, male sex, quantity of RF, PAD and patients referred by HUPE were risk predictors for CAD; male sex, older age, NIDM and DLP were risk predictors for LM disease. The low rate of procedure complications demonstrates the safety of coronary angiography in a tertiary university hospital. |
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Albuquerque, Denilson Campos dehttp://lattes.cnpq.br/5219627521398631Ferreira, Esmeralcihttp://lattes.cnpq.br/6211786708672782Esporcatte, Robertohttp://lattes.cnpq.br/7834473588314438Bomfim, Alfredo de Souzahttp://lattes.cnpq.br/0717157256863644Zukowski, Cleverson Neveshttp://lattes.cnpq.br/9373124092231626http://lattes.cnpq.br/3690080414255645da Costa, Guilherme Barros Ferreiragiokosta@hotmail.com2023-12-05T13:33:00Z2019-11-25COSTA, Guilherme Barros Ferreira. Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário. 2019. 72 f. Dissertação (Mestrado em Ciências Médicas) – Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2019.http://www.bdtd.uerj.br/handle/1/20739Ischemic heart disease is one of the most common causes of death worldwide. There are few data in the literature about the association of clinical profile and coronary angiography results in our population. From August 2015 to April 2018, 1 844 patients submitted to coronary angiography at Hospital Universitário Pedro Ernesto (HUPE) were enrolled in this cross-sectional study. They were evaluated by their clinical variables, angiographic results and procedure complications. Results: mean age 62,1±10,3 years, mean body mass index (BMI) 27,4±5,0 kg/m² and 26,3% were obese. Most of the population were outpatients (71,0%). Patients referred by HUPE were 15,5% of population. Stable angina was the most common indication (62,9%). Only 19,7% underwent noninvasive testing (NT). Arterial hypertension (AH) was the most prevalent RF (88,2%), followed by dyslipidemia (DLP) with 60,2%. Only 4,2% of population did not have any RF. Transradial approach was used in 91,7% of patients. Most patients (65%) had obstructive CAD (intermediate and severe stenosis) and 58,2% when considered only severe stenosis CAD. Mild and severe left main coronary artery (LM) disease was found in 8,1% of patients and 4,7% when considered only severe stenosis. AH, DLP, diabetes mellitus (DM), family history (FH) of CAD, smoking, peripheral artery disease (PAD) and chronic kidney disease (CKD) were associated with CAD (p<0,05) and worse angiographic results. DM and DLP were associated (p<0,05) with LM disease. Obesity and NT were not associated with CAD. The quantity of RF, male sex, older age group and patients referred by HUPE were considered independent risk predictors for CAD after multivariable analysis. LM disease independent risk predictors were male sex, older age group, non-insulin-dependent DM (NIDM) and DLP. Death occurred in 3 (0,16%) patients and acute coronary occlusion in 4 (0,2%). In conclusion: classic risk factors were associated with the presence of CAD. Older age, male sex, quantity of RF, PAD and patients referred by HUPE were risk predictors for CAD; male sex, older age, NIDM and DLP were risk predictors for LM disease. The low rate of procedure complications demonstrates the safety of coronary angiography in a tertiary university hospital.A doença isquêmica do coração é uma das principais causas de morte no mundo. Existem poucos dados na literatura sobre a associação do perfil clínico com resultados da coronariografia. Este estudo tem por objetivo avaliar o perfil clínico e suas associações com os resultados angiográficos em pacientes submetidos à coronariografia em hospital público universitário. Realizado estudo epidemiológico, observacional do tipo transversal com 1844 pacientes submetidos a coronariografia no Hospital Universitário Pedro Ernesto (HUPE), de agosto de 2015 a abril de 2018. Avaliados as variáveis clínicas, os resultados angiográficos e as complicações. Os resultados encontrados foram: média de idade: 62,1±10,3 anos, média de IMC: 27,4±5,0 kg/m2 com 26,3% de obesos. A maior parte da população estudada teve origem ambulatorial (71,0%). Para a indicação do procedimento, 15,5% dos pacientes foram referidos pelo HUPE. Angina estável foi a principal indicação (62,9%). Apenas 19,7% da população estudada realizou algum teste não invasivo para isquemia miocárdica (TNI). Comorbidades mais frequentes: hipertensão arterial sistêmica (HAS) com 88,2%, seguida de dislipidemia (DLP) com 60,2%. Apenas 4,2% da população estudada não apresentava FR. A via de acesso arterial mais utilizada foi a radial (91,7%). A maior parte dos pacientes estudados apresentou DAC obstrutiva (moderada/grave) com 65,0% dos casos e 58,2% DAC grave (apenas lesões graves). Lesão de tronco da coronária esquerda (TCE) moderada/grave foi encontrada em 8,1% dos pacientes e em 4,7% quando consideradas apenas lesões graves. HAS, DLP, diabetes mellitus (DM), história familiar (HF) para DAC, tabagismo, doença arterial obstrutiva periférica (DAOP) e insuficiência renal crônica (IRC) demonstraram associação (p<0,05) com a presença de DAC moderada/grave, DAC grave e resultados angiográficos piores. DM e DLP apresentaram associação (p<0,05) com lesão de TCE. Obesidade e a realização de algum TNI não apresentaram associação com DAC. A análise multivariada demonstrou que o número de FR, sexo masculino, faixa etária elevada e origem da indicação pelo HUPE foram preditores de risco independentes para DAC. Em relação à lesão de TCE, os preditores de risco independentes foram: sexo masculino, faixa etária elevada, DM não insulinodependente (DMNID) e DLP. Óbito ocorreu em 3 (0,16%) pacientes e oclusão aguda de artéria coronária em 4 (0,2%). As conclusões deste estudo são: os fatores de risco clássicos demonstraram associação com DAC. Os preditores para DAC foram: faixa etária elevada, sexo masculino, número de fatores de risco, DAOP e origem HUPE; e para TCE foram: sexo masculino, idade avançada, DMNID e DLP. O baixo número de complicações identifica a segurança da coronariografia em hospital público universitário.Submitted by Heloísa CB/A (helobdtd@gmail.com) on 2023-12-05T13:33:00Z No. of bitstreams: 1 Dissertação - Guilherme Barros Ferreira da Costa - 2019 - Completa.pdf: 2683229 bytes, checksum: f017b57897822f9e4129a6ab4629f12f (MD5)Made available in DSpace on 2023-12-05T13:33:00Z (GMT). No. of bitstreams: 1 Dissertação - Guilherme Barros Ferreira da Costa - 2019 - Completa.pdf: 2683229 bytes, checksum: f017b57897822f9e4129a6ab4629f12f (MD5) Previous issue date: 2019-11-25application/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Ciências MédicasUERJBrasilCentro Biomédico::Faculdade de Ciências MédicasCoronary artery diseaseRisk factorsCoronary angiographyComplicationsDoença das coronáriasFatores de riscoCoronariografiaComplicaçõesCIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICAPerfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitárioClinical profile associations with angiographic results of patients undergoing coronary angiography in a public university hospitalinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALDissertação - Guilherme Barros Ferreira da Costa - 2019 - Completa.pdfDissertação - Guilherme Barros Ferreira da Costa - 2019 - Completa.pdfapplication/pdf2683229http://www.bdtd.uerj.br/bitstream/1/20739/2/Disserta%C3%A7%C3%A3o+-+Guilherme+Barros+Ferreira+da+Costa+-+2019+-+Completa.pdff017b57897822f9e4129a6ab4629f12fMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82123http://www.bdtd.uerj.br/bitstream/1/20739/1/license.txte5502652da718045d7fcd832b79fca29MD511/207392024-02-26 15:59:52.257oai:www.bdtd.uerj.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T18:59:52Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false |
dc.title.por.fl_str_mv |
Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário |
dc.title.alternative.eng.fl_str_mv |
Clinical profile associations with angiographic results of patients undergoing coronary angiography in a public university hospital |
title |
Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário |
spellingShingle |
Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário da Costa, Guilherme Barros Ferreira Coronary artery disease Risk factors Coronary angiography Complications Doença das coronárias Fatores de risco Coronariografia Complicações CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA |
title_short |
Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário |
title_full |
Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário |
title_fullStr |
Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário |
title_full_unstemmed |
Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário |
title_sort |
Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário |
author |
da Costa, Guilherme Barros Ferreira |
author_facet |
da Costa, Guilherme Barros Ferreira giokosta@hotmail.com |
author_role |
author |
author2 |
giokosta@hotmail.com |
author2_role |
author |
dc.contributor.advisor1.fl_str_mv |
Albuquerque, Denilson Campos de |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/5219627521398631 |
dc.contributor.advisor-co1.fl_str_mv |
Ferreira, Esmeralci |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/6211786708672782 |
dc.contributor.referee1.fl_str_mv |
Esporcatte, Roberto |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/7834473588314438 |
dc.contributor.referee2.fl_str_mv |
Bomfim, Alfredo de Souza |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/0717157256863644 |
dc.contributor.referee3.fl_str_mv |
Zukowski, Cleverson Neves |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/9373124092231626 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/3690080414255645 |
dc.contributor.author.fl_str_mv |
da Costa, Guilherme Barros Ferreira giokosta@hotmail.com |
contributor_str_mv |
Albuquerque, Denilson Campos de Ferreira, Esmeralci Esporcatte, Roberto Bomfim, Alfredo de Souza Zukowski, Cleverson Neves |
dc.subject.eng.fl_str_mv |
Coronary artery disease Risk factors Coronary angiography Complications |
topic |
Coronary artery disease Risk factors Coronary angiography Complications Doença das coronárias Fatores de risco Coronariografia Complicações CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA |
dc.subject.por.fl_str_mv |
Doença das coronárias Fatores de risco Coronariografia Complicações |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA |
description |
Ischemic heart disease is one of the most common causes of death worldwide. There are few data in the literature about the association of clinical profile and coronary angiography results in our population. From August 2015 to April 2018, 1 844 patients submitted to coronary angiography at Hospital Universitário Pedro Ernesto (HUPE) were enrolled in this cross-sectional study. They were evaluated by their clinical variables, angiographic results and procedure complications. Results: mean age 62,1±10,3 years, mean body mass index (BMI) 27,4±5,0 kg/m² and 26,3% were obese. Most of the population were outpatients (71,0%). Patients referred by HUPE were 15,5% of population. Stable angina was the most common indication (62,9%). Only 19,7% underwent noninvasive testing (NT). Arterial hypertension (AH) was the most prevalent RF (88,2%), followed by dyslipidemia (DLP) with 60,2%. Only 4,2% of population did not have any RF. Transradial approach was used in 91,7% of patients. Most patients (65%) had obstructive CAD (intermediate and severe stenosis) and 58,2% when considered only severe stenosis CAD. Mild and severe left main coronary artery (LM) disease was found in 8,1% of patients and 4,7% when considered only severe stenosis. AH, DLP, diabetes mellitus (DM), family history (FH) of CAD, smoking, peripheral artery disease (PAD) and chronic kidney disease (CKD) were associated with CAD (p<0,05) and worse angiographic results. DM and DLP were associated (p<0,05) with LM disease. Obesity and NT were not associated with CAD. The quantity of RF, male sex, older age group and patients referred by HUPE were considered independent risk predictors for CAD after multivariable analysis. LM disease independent risk predictors were male sex, older age group, non-insulin-dependent DM (NIDM) and DLP. Death occurred in 3 (0,16%) patients and acute coronary occlusion in 4 (0,2%). In conclusion: classic risk factors were associated with the presence of CAD. Older age, male sex, quantity of RF, PAD and patients referred by HUPE were risk predictors for CAD; male sex, older age, NIDM and DLP were risk predictors for LM disease. The low rate of procedure complications demonstrates the safety of coronary angiography in a tertiary university hospital. |
publishDate |
2019 |
dc.date.issued.fl_str_mv |
2019-11-25 |
dc.date.accessioned.fl_str_mv |
2023-12-05T13:33:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
COSTA, Guilherme Barros Ferreira. Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário. 2019. 72 f. Dissertação (Mestrado em Ciências Médicas) – Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2019. |
dc.identifier.uri.fl_str_mv |
http://www.bdtd.uerj.br/handle/1/20739 |
identifier_str_mv |
COSTA, Guilherme Barros Ferreira. Perfil clínico e suas associações com resultados angiográficos de pacientes submetidos à coronariografia em hospital público universitário. 2019. 72 f. Dissertação (Mestrado em Ciências Médicas) – Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2019. |
url |
http://www.bdtd.uerj.br/handle/1/20739 |
dc.language.iso.fl_str_mv |
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por |
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dc.publisher.none.fl_str_mv |
Universidade do Estado do Rio de Janeiro |
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Programa de Pós-Graduação em Ciências Médicas |
dc.publisher.initials.fl_str_mv |
UERJ |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Centro Biomédico::Faculdade de Ciências Médicas |
publisher.none.fl_str_mv |
Universidade do Estado do Rio de Janeiro |
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