Associação entre as calcificações vasculares na mamografia e a estenose coronária em mulheres na pós-menopausa
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2022-05-13
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Universidade Estadual Paulista (Unesp)
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Objetivo: avaliar a associação entre a presença de calcificação vascular mamária (CVM) na mamografia e da doença arterial coronariana (DAC) na angiografia coronária invasiva em mulheres na pós-menopausa. Métodos: Realizou-se estudo clínico de corte transversal. Foram incluídas mulheres na pós-menopausa (idade ≥ 45 anos) com DAC, submetidas a procedimento de angiografia coronária invasiva em Hospital Universitário, nível terciário de atendimento, no período de 2012 a 2020 e que apresentassem mamografia digitalizada no sistema eletrônico de prontuários datada de até 6 meses da angiografia. Foram excluídas mulheres submetidas a revascularização miocárdica prévia e com densidade mamária grau D (BI-RADS) ou câncer de mama na mamografia. Todas as mamografias foram reanalisadas sem conhecimento dos dados clínicos das pacientes, quanto a presença ou ausência de CVM. A partir do prontuário eletrônico foram coletados dados clínicos, bioquímicos e resultado da angiografia coronária, analisada de acordo com o número de vasos comprometidos: doença uniarterial; doença de dois vasos; doença multiarterial (≥3 vasos). Para análise estatística foram empregados: Teste t-student, distribuição Gama, teste do Quiquadrado e Regressão logística (odds ratio, OR). Resultados: Entre as 183 mulheres incluídas, 39 (21,3%) apresentaram CVM. As mulheres com CVM eram em média mais velhas e com maior tempo de pósmenopausa quando comparadas as mulheres sem calcificação (68.2 ± 9.6 anos x 59.6 ± 10.0 anos e 19 ± 10.1 anos x 13.5 ± 8.2 anos, respectivamente) (p<.0001). Na associação entre as características clínicas e cardiovasculares foi observada maior 11 ocorrência de tabagismo entre as mulheres com ausência de CVM (p=0.007). Não houve diferença no número de vasos comprometidos na angiografia coronária entre as mulheres com ou sem CVM (p=0.683). Na análise de risco, considerando a CVM como a variável resposta, a idade foi fator de risco (OR 1.19; IC 95% 1.10-1.33, p=0.016) e o tabagismo fator protetor (OR 0.21; IC 95% 0.06-0.69, p=0.010). Na análise de risco ajustado para idade, tempo de menopausa e tabagismo, a CVM não se associou a risco significativo para maior número de vasos comprometidos na angiografia coronária (OR 1.07; IC 95% 0.41-2.76, p=0.609). Conclusão: A presença de calcificação vascular mamária na mamografia digital não se associou à doença arterial coronariana na angiografia coronariana invasiva em mulheres na pós-menopausa.
Objective: to evaluate the association between the presence of breast arterial calcification (BAC) on digital mammography and coronary artery disease (CAD) on invasive coronary angiography (ICA) in postmenopausal women. Methods: This is a cross-sectional study. Postmenopausal women (age ≥45 years) with history of CAD who underwent both ICA and digitalized mammography, within six months of each other, were included. Women who had undergone previous percutaneous coronary intervention, and with grade D breast density (BI-RADS) or breast cancer on mammography were excluded. Digital Mammograms were identified on the electronic medical record system and reviewed for the presence of BAC, blind to the results of ICA or any other patient’s clinical data. The ICA results were collected from the electronic medical record, and categorized as follows: 1- single-vessel disease; 2- two-vessel disease; and 3-multivessel disease (≥3 vessels). For statistical analysis: Student t test, Gamma distribution, Chi-square test and logistic regression (odds ratio, OR) were used. Results: Among 183 postmenopausal women evaluated, 39 (21.3%) had BAC. Women with BAC were older and had a longer time since menopause when compared to women without BAC (68.2 ± 9.6 x 59.6 ± 10.0 years and 19 ± 10.1 x 13.5 ± 8.2 years, respectively) (p<.0001). In the association between clinical and cardiovascular characteristics, only a higher occurrence of smoking was observed among women with BAC (p = 0.007). There was no difference in the number of vessels involved in ICA between women with or without BAC (p = 0.683). In the risk analysis, considering BAC as the response variable, age was a risk factor (OR 1.19; 95% CI 1.10-1.33, p= 0.016) 13 and smoking was a protective factor (OR 0.21; 95% CI 0.06- 0.69, p= 0.010). In multivariate analysis, after adjustment for for age, time since menopause and smoking, the presence of BAC was not associated with a significant risk for a greater number of vessels involved in ICA (OR 1.07; 95% CI 0.41-2.76, p = 0.609). Conclusions: The presence of breast arterial calcification on digital mammography was not associated with the severity of coronary artery disease on invasive coronary angiography in postmenopausal women.
Objective: to evaluate the association between the presence of breast arterial calcification (BAC) on digital mammography and coronary artery disease (CAD) on invasive coronary angiography (ICA) in postmenopausal women. Methods: This is a cross-sectional study. Postmenopausal women (age ≥45 years) with history of CAD who underwent both ICA and digitalized mammography, within six months of each other, were included. Women who had undergone previous percutaneous coronary intervention, and with grade D breast density (BI-RADS) or breast cancer on mammography were excluded. Digital Mammograms were identified on the electronic medical record system and reviewed for the presence of BAC, blind to the results of ICA or any other patient’s clinical data. The ICA results were collected from the electronic medical record, and categorized as follows: 1- single-vessel disease; 2- two-vessel disease; and 3-multivessel disease (≥3 vessels). For statistical analysis: Student t test, Gamma distribution, Chi-square test and logistic regression (odds ratio, OR) were used. Results: Among 183 postmenopausal women evaluated, 39 (21.3%) had BAC. Women with BAC were older and had a longer time since menopause when compared to women without BAC (68.2 ± 9.6 x 59.6 ± 10.0 years and 19 ± 10.1 x 13.5 ± 8.2 years, respectively) (p<.0001). In the association between clinical and cardiovascular characteristics, only a higher occurrence of smoking was observed among women with BAC (p = 0.007). There was no difference in the number of vessels involved in ICA between women with or without BAC (p = 0.683). In the risk analysis, considering BAC as the response variable, age was a risk factor (OR 1.19; 95% CI 1.10-1.33, p= 0.016) 13 and smoking was a protective factor (OR 0.21; 95% CI 0.06- 0.69, p= 0.010). In multivariate analysis, after adjustment for for age, time since menopause and smoking, the presence of BAC was not associated with a significant risk for a greater number of vessels involved in ICA (OR 1.07; 95% CI 0.41-2.76, p = 0.609). Conclusions: The presence of breast arterial calcification on digital mammography was not associated with the severity of coronary artery disease on invasive coronary angiography in postmenopausal women.
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Calcificação vascular mamária, Mamografia, Doença arterial coronariana, Angiografia coronária invasiva, Menopausa