Avaliação da associação entre a presença de doença periodontal e reestenose de stent convencional: estudo caso controle
Carregando...
Arquivos
Data
2018-11-30
Autores
Osugue, Raphael Kazuo [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
A doença arterial coronária (DAC), assim como a doença periodontal (PD) são patologias muito prevalentes e apresentam vias em comum na sua fisiopatologia que é a inflamação crônica. A angioplastia coronária percutânea com implante de stent se estabeleceu como a principal forma de revascularização miocárdica no tratamento da DAC porém cerca de 16% a 44% dos pacientes podem evoluir com reestenose do stent. Se a doença periodontal, pelo seu estado inflamatório sistêmico crônico estaria contribuindo para um aumento nas taxas de reestenose de stents convencionais não está definido e não é uma rotina na prática clínica a avaliação da cavidade oral antes de um procedimento de angioplastia coronária. O objetivo primário do estudo foi avaliar a correlação entre a doença periodontal com a incidência de reestenose do stent, enquanto os objetivos secundários foram avaliar a prevalência da doença periodontal, o número de dentes, o grau de perda óssea e finalmente a gravidade da doença periodontal na população do estudo. Para isto realizamos um estudo pioneiro, retrospectivo, caso controle e em um único centro no período de janeiro de 2016 a fevereiro de 2018. Foram analisados 1685 exames de cinecoronariografia dos quais 283 apresentavam imagem de stent com e sem reestenose sendo incluídos 49 pacientes separados entre o grupo caso, com reestenose (n=15) e o grupo controle, sem reestenose (n=34). Excluímos os pacientes portadores de Diabetes Mellitus (DM) não controlados, portadores de stents do tipo farmacológico ou aqueles que possuem reestenose de stents implantados há mais de dois anos. Para análise estatística foram utilizados o teste de qui-quadrado nas variáveis qualitativas, teste de ANOVA para variáveis quantitativas., cálculo do Odds Ratio e o teste de Igualdade de Duas Proporções para comparar os grupos de reestenose com a distribuição do tipo de doença periodontal. Não encontramos diferença estatisticamente significativa entre a doença periodontal e a reestenose de stent OR 1,12 (IC 95%: 0,82-1,53) com p=0,414. A prevalência da doença periodontal foi bastante elevada 79% (n=39), a média do número de dentes entre os grupos foi de 16,4 para grupo caso e 18,2 para o grupo controle, o grau de perda óssea foi de 50,6% no grupo Caso e 53% no grupo controle e finalmente a gravidade da doença periodontal na população do estudo foi bastante heterógena entre os grupos. Dentro dos limites do presente estudo, não podemos inferir se existe uma correlação da doença periodontal com a reestenose dos stents implantados. Porém fica claro que a saúde bucal neste perfil de pacientes e altamente precária pela alta prevalência de doença periodontal, pela grande quantidade de perda dentária e perda óssea observada em ambos os grupos e a gravidade da doença periodontal em diferentes estágios sendo inclusive um dos fatores que prejudicou a obtenção da amostra a grande prevalência de edêntulos com doença coronária pré estabelecida. Futuros estudos com amostras maiores são necessários para confirmar essa hipótese.
Coronary artery disease (CAD), as well as periodontal disease (PD) are very prevalent pathologies and present common pathways in their pathophysiology which is chronic inflammation. Percutaneous coronary angioplasty with stent implantation has been established as the main form of myocardial revascularization in the treatment of CAD but about 16% to 44% of patients may evolve with stent restenosis. If periodontal disease, because of its chronic systemic inflammatory state would be contributing to an increase in the rates of restenosis of conventional stents is not defined and it is not a routine in clinical practice to evaluate the oral cavity before a coronary angioplasty procedure. The primary objective of the study was to evaluate the correlation between periodontal disease and the incidence of stent restenosis, while the secondary objectives were to evaluate the prevalence of periodontal disease, number of teeth, degree of bone loss and finally severity of periodontal disease in the study population. For this, we conducted a pioneering, retrospective, case control and single-center study from January 2016 to February 2018. We analyzed 1685 coronary angiography exams, of which 283 presented stent imaging with and without restenosis and 49 patients were separated between the case group, with restenosis (n = 15) and the control group, without restenosis (n = 34). We excluded patients with uncontrolled diabetes mellitus (DM), those with stents of the pharmacological type or those with restenosis from stents implanted more than two years ago. For statistical analysis, the chi-square test in the qualitative variables, ANOVA test for quantitative variables, Odds Ratio calculation and Equality of Two Proportions test were used to compare the restenosis groups with the distribution of the type of periodontal disease. We found no statistically significant difference between periodontal disease and OR stent restenosis 1.12 (95% CI: 0.82-1.53) with p = 0.414. The prevalence of periodontal disease was very high (79%) (n = 39), the mean number of teeth between the groups was 16.4 for the case group and 18.2 for the control group, the degree of bone loss was 50,6% in the Case group and 53% in the control group, and finally the severity of periodontal disease in the study population was quite heterogenous between the groups. Within the limits of the present study, we can not infer if there is a correlation of the periodontal disease with the restenosis of the implanted stents. However, it is clear that oral health in this patient profile is highly precarious due to the high prevalence of periodontal disease, the great amount of tooth loss and bone loss observed in both groups and the severity of periodontal disease in different stages, being one of the factors that the prevalence of edentulous patients with pre-established coronary disease was impaired. Further studies with larger samples are needed to confirm this hypothesis.
Coronary artery disease (CAD), as well as periodontal disease (PD) are very prevalent pathologies and present common pathways in their pathophysiology which is chronic inflammation. Percutaneous coronary angioplasty with stent implantation has been established as the main form of myocardial revascularization in the treatment of CAD but about 16% to 44% of patients may evolve with stent restenosis. If periodontal disease, because of its chronic systemic inflammatory state would be contributing to an increase in the rates of restenosis of conventional stents is not defined and it is not a routine in clinical practice to evaluate the oral cavity before a coronary angioplasty procedure. The primary objective of the study was to evaluate the correlation between periodontal disease and the incidence of stent restenosis, while the secondary objectives were to evaluate the prevalence of periodontal disease, number of teeth, degree of bone loss and finally severity of periodontal disease in the study population. For this, we conducted a pioneering, retrospective, case control and single-center study from January 2016 to February 2018. We analyzed 1685 coronary angiography exams, of which 283 presented stent imaging with and without restenosis and 49 patients were separated between the case group, with restenosis (n = 15) and the control group, without restenosis (n = 34). We excluded patients with uncontrolled diabetes mellitus (DM), those with stents of the pharmacological type or those with restenosis from stents implanted more than two years ago. For statistical analysis, the chi-square test in the qualitative variables, ANOVA test for quantitative variables, Odds Ratio calculation and Equality of Two Proportions test were used to compare the restenosis groups with the distribution of the type of periodontal disease. We found no statistically significant difference between periodontal disease and OR stent restenosis 1.12 (95% CI: 0.82-1.53) with p = 0.414. The prevalence of periodontal disease was very high (79%) (n = 39), the mean number of teeth between the groups was 16.4 for the case group and 18.2 for the control group, the degree of bone loss was 50,6% in the Case group and 53% in the control group, and finally the severity of periodontal disease in the study population was quite heterogenous between the groups. Within the limits of the present study, we can not infer if there is a correlation of the periodontal disease with the restenosis of the implanted stents. However, it is clear that oral health in this patient profile is highly precarious due to the high prevalence of periodontal disease, the great amount of tooth loss and bone loss observed in both groups and the severity of periodontal disease in different stages, being one of the factors that the prevalence of edentulous patients with pre-established coronary disease was impaired. Further studies with larger samples are needed to confirm this hypothesis.
Descrição
Palavras-chave
Estudo observacional, Reestenose coronária, Doenças periodontais, Observational study, Coronary restenosis, Periodontal disease