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. 2023 Oct;120(10):e20220440.
doi: 10.36660/abc.20220440.

Two-Year Follow-Up of Chronic Ischemic Heart Disease Patients in a Specialized Center in Brazil

[Article in English, Portuguese]
Eduardo Martelli Moreira  1 , Henrique Trombini Pinesi  1 , Eduardo Bello Martins  1 , Fábio Grunspun Pitta  1 , Paula Mathias Paulino Bolta  1 , Carlos Alexandre Wainrober Segre  1 , Desiderio Favarato  1 , Fabiana Hanna Rached  1 , Whady Armindo Hueb  1 , Eduardo Gomes Lima  1 , Roberto Kalil Filho  1 , Cibele Larrosa Garzillo  1 , Carlos Vicente Serrano Jr  1
Affiliations

Two-Year Follow-Up of Chronic Ischemic Heart Disease Patients in a Specialized Center in Brazil

[Article in English, Portuguese]
Eduardo Martelli Moreira et al. Arq Bras Cardiol. 2023 Oct.

Abstract
in English, Portuguese

The incidence of cardiovascular events in patients with chronic ischemic heart disease (CIHD) may vary significantly among countries. Although populous, Brazil is often underrepresented in international records. This study aimed to describe the quality of care and the two-year incidence of cardiovascular events and associated prognostic factors in CIHD patients in a tertiary public health care center in Brazil. Patients with CIHD who reported for clinical evaluation at Instituto do Coração (São Paulo, Brazil) were registered and followed for two years. The primary endpoint was a composite of myocardial infarction (MI), stroke, or death. A significance level of 0.05 was adopted. From January 2016 to December 2018, 625 participants were included in the study. Baseline characteristics show that 33.1% were women, median age 66.1 [59.6 - 71.9], 48.6% had diabetes, 83.1% had hypertension, 62.6% had previous MI, and 70.4% went through some revascularization procedure. At a median follow-up (FU) of 881 days, we noted 37 (7.05%) primary endpoints. After adjustments, age, previous stroke, and LDL-cholesterol were independently associated with the primary endpoint. Comparing baseline versus FU, participants experienced relief of angina based on the Canadian Cardiovascular Society (CCS) scale according to the following percentages: 65.7% vs. 81.7% were asymptomatic and 4.2% vs. 2.9% CCS 3 or 4 (p < 0.001). They also experienced better quality of medication prescription: 65.8% vs. 73.6% (p < 0.001). However, there was no improvement in LDL-cholesterol or blood pressure control. This study shows that CIHD patients had a two-year incidence of the primary composite endpoint of 7.05%, and the reduction of LDL-cholesterol was the only modifiable risk factor associated with prognosis.

A incidência de eventos cardiovasculares em pacientes com doença cardíaca isquêmica crônica (DCIC) pode variar significativamente entre os países. Embora populoso, o Brasil é frequentemente sub-representado nos registros internacionais. Este estudo teve como objetivo descrever a qualidade do atendimento e a incidência de eventos cardiovasculares em dois anos, além de fatores prognósticos associados em pacientes com DCIC em um centro terciário de saúde pública no Brasil. Pacientes com DCIC que compareceram para avaliação clínica no Instituto do Coração (São Paulo, Brasil) foram cadastrados e acompanhados por dois anos. O desfecho primário foi um composto de infarto do miocárdio (IM), acidente vascular encefálico ou morte. Um nível de significância de 0,05 foi adotado. De janeiro de 2016 a dezembro de 2018, 625 participantes foram incluídos no estudo. As características basais mostram que 33,1% eram mulheres, a idade mediana era de 66,1 [59,6 – 71,9], 48,6% tinham diabetes, 83,1% tinham hipertensão, 62,6% tinham IM prévio e 70,4% passaram por algum procedimento de revascularização. Em um acompanhamento mediano de 881 dias, 37 (7,05%) desfechos primários foram observados. Após ajustes, idade, acidente vascular encefálico prévio e colesterol LDL foram independentemente associados ao desfecho primário. Comparando a linha de base com o acompanhamento, os participantes relataram alívio da angina com base na escala da Sociedade Cardiovascular Canadense (SCC) de acordo com as seguintes porcentagens: 65,7% vs. 81,7% eram assintomáticos e 4,2% vs. 2,9% eram SCC 3 ou 4 (p < 0,001). Eles também relataram melhor qualidade na prescrição de medicamentos: 65,8% vs. 73,6% (p < 0,001). No entanto, não houve melhora no colesterol LDL ou no controle da pressão arterial. O presente estudo mostra que pacientes com DCIC apresentaram uma incidência de 7,05% do desfecho primário composto em um período de dois anos, sendo a diminuição do colesterol LDL o único fator de risco modificável associado ao prognóstico.

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Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

None
: Acompanhamento de Dois Anos de Pacientes com Cardiopatia Isquêmica Crônica em um Centro Especializado no Brasil
Figura 1
Figura 1. – Número de pacientes com objetivos clínicos alcançados. IECA: inibidor da enzima conversora de angiotensina; BRA: bloqueadores dos receptores da angiotensina; Antitrombóticos: antiplaquetários e/ou anticoagulantes orais; LDL-c: colesterol lipoproteico de baixa densidade; PAS: pressão arterial sistólica.
Figura 2
Figura 2. – Intensidade da angina na linha de base e no acompanhamento. SCC: Sociedade Cardiovascular Canadense; Assint.: assintomáticos.
Figura 3
Figura 3. – Incidência de infarto do miocárdio, acidente vascular encefálico ou morte, estratificada por fatores prognósticos independentes. LDL: lipoproteína de baixa densidade.
None
: Two-Year Follow-Up of Chronic Ischemic Heart Disease Patients in a Specialized Center in Brazil
Figure 1
Figure 1. – Number of patients that achieved clinical goals. ACEi: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blockers; Antithrombotic: antiplatelets and/or oral anticoagulants; LDL-c: low-density lipoprotein cholesterol; SBP: systolic blood pressure.
Figure 2
Figure 2. – Angina intensity at baseline and follow-up. CCS: Canadian Cardiovascular Society; Asymptom.: asymptomatic.
Figure 3
Figure 3. – Incidence of myocardial infarction, stroke, or death, stratified by independent prognostic factors. LDL: low-density lipoprotein.
See this image and copyright information in PMC

Comment in

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