Tratamento da doença arterial coronariana em renais crônicos em diálise do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP
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Data
2007-05-01
Autores
Vieira, Paula Ferreiro [UNESP]
Garcia, Paula Dalsoglio [UNESP]
Bregagnollo, Edson Antônio [UNESP]
Carvalho, Fábio Cardoso [UNESP]
Kochi, Ana Cláudia [UNESP]
Martins, Antonio Sérgio [UNESP]
Caramori, Jaqueline Costa Teixeira [UNESP]
Franco, Roberto Jorge da Silva [UNESP]
Barretti, Pasqual [UNESP]
Martin, Luis Cuadrado [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Sociedade Brasileira de Cardiologia (SBC)
Resumo
FUNDAMENTO: O tratamento intervencionista da insuficiência coronariana é subempregado nos pacientes em diálise, pois há poucos estudos comprovando sua eficácia. OBJETIVO: Avaliar os resultados do tratamento intervencionista da doença arterial coronariana em pacientes tratados por diálise no HC da FMB. MÉTODOS: Foram avaliados 34 pacientes em diálise submetidos à angiografia coronariana entre set/95 e out/04, divididos de acordo com a presença ou ausência de lesão coronariana, tipo de tratamento e presença ou ausência de diabetes. Os grupos foram comparados de acordo com suas características clínicas e sobrevida. A sobrevida dos pacientes submetidos a tratamento intervencionista foi comparada à sobrevida geral dos 146 pacientes em diálise na instituição no mesmo período. O tratamento intervencionista foi indicado nas mesmas situações clínicas que na população geral. RESULTADOS: Os 13 pacientes que realizaram coronariografia e não exibiam lesões coronarianas apresentaram sobrevida de 100% em 48 meses, contra 35% dos 21 coronarianos no mesmo período. Os diabéticos coronarianos apresentaram sobrevida inferior aos não-diabéticos. A angioplastia exibiu pior prognóstico quando comparada à cirurgia; entretanto 80% dos submetidos a angioplastia eram diabéticos. Os 17 pacientes submetidos a procedimentos de revascularização coronariana apresentaram sobrevida semelhante aos 146 pacientes gerais do serviço. CONCLUSÃO: Esta pequena casuística mostra que a revascularização miocárdica, quando indicada, pode ser realizada em pacientes em diálise. Esta conclusão é corroborada pelo índice de mortalidade semelhante nos dois extratos de pacientes: coronarianos revascularizados e pacientes em diálise de maneira geral.
BACKGROUND: Interventional treatment of coronary insufficiency is underemployed among dialysis patients. Studies confirming its efficacy in this set of patients are scarce. OBJECTIVE: To assess the results of interventional treatment of coronary artery disease in patients undergoing dialysis. METHODS: A total of 34 dialysis patients submitted to coronary angiography between September 1995 and October 2004 were divided according to presence or absence of coronary lesion, type of treatment and presence or absence of diabetes mellitus. The groups were compared according to their clinical and survival characteristics. Survival of patients undergoing interventional treatment was compared to overall survival of 146 dialysis patients at the institution in the same period. Interventional treatment was indicated to the same clinical conditions in the general population. RESULTS: Thirteen patients with no angiography coronary lesions presented a survival rate of 100% in 48 months as compared to 35% of 21 patients with coronary artery disease. Diabetic patients had a lower survival rate compared with non-diabetics. Angioplasty had a worse prognosis compared to surgery; however, 80% of patients undergoing angioplasty were diabetic. Seventeen patients submitted to interventional procedures presented a survival rate similar to that of the others 146 hemodialysis patients without clinical evidence of coronary disease. CONCLUSION: This small series shows that myocardial revascularization, whenever indicated, can be performed in dialysis patients. This conclusion is corroborated by similar mortality rates in two groups of patients: coronary patients submitted to revascularization and overall dialysis patients.
BACKGROUND: Interventional treatment of coronary insufficiency is underemployed among dialysis patients. Studies confirming its efficacy in this set of patients are scarce. OBJECTIVE: To assess the results of interventional treatment of coronary artery disease in patients undergoing dialysis. METHODS: A total of 34 dialysis patients submitted to coronary angiography between September 1995 and October 2004 were divided according to presence or absence of coronary lesion, type of treatment and presence or absence of diabetes mellitus. The groups were compared according to their clinical and survival characteristics. Survival of patients undergoing interventional treatment was compared to overall survival of 146 dialysis patients at the institution in the same period. Interventional treatment was indicated to the same clinical conditions in the general population. RESULTS: Thirteen patients with no angiography coronary lesions presented a survival rate of 100% in 48 months as compared to 35% of 21 patients with coronary artery disease. Diabetic patients had a lower survival rate compared with non-diabetics. Angioplasty had a worse prognosis compared to surgery; however, 80% of patients undergoing angioplasty were diabetic. Seventeen patients submitted to interventional procedures presented a survival rate similar to that of the others 146 hemodialysis patients without clinical evidence of coronary disease. CONCLUSION: This small series shows that myocardial revascularization, whenever indicated, can be performed in dialysis patients. This conclusion is corroborated by similar mortality rates in two groups of patients: coronary patients submitted to revascularization and overall dialysis patients.
Descrição
Palavras-chave
Insuficiência renal crônica, doença arterial coronariana, revascularização miocárdica, Renal insufficiency, chronic, coronary artery disease, myocardial revascularization
Como citar
Arquivos Brasileiros de Cardiologia. Sociedade Brasileira de Cardiologia - SBC, v. 88, n. 5, p. 525-530, 2007.