Complications – ABC CARDIOL

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Editorial

Registries and Evidence-Based Medicine

Since the landmark achievement of Rene Favaloro in 1967, coronary artery bypass grafting (CABG) has developed great advances. Despite the widespread adoption of percutaneous coronary intervention with stenting, CABG remains an extremely important invasive treatment option in patients with coronary artery disease. Coronary artery bypass grafting has been extensively investigated in the literature through many randomized controlled trials and large-scale multicenter and unicenter observational registries, which have provided appropriateness of decision in a patient-centered approach, achieving the highest level of recommendation in many clinical scenarios.

In this issue of Arquivos Brasileiros de Cardiologia, a manuscript entitled “Age, Renal Failure and Transfusion are Risk Predictors of Prolonged Hospital Stay after Coronary Artery Bypass Grafting Surgery” addresses an important issue. The authors aimed to determine factors associated with prolonged postoperative hospital length of stay, defined as greater than 14 days. The authors studied 3703 patients submitted to CABG over 2 years, using the Sao Paulo State Registry REPPLICAR II. This data is out of date in about 5 years. They have found that 6.16% of patients had prolonged postoperative length of stay, being the preoperative and intraoperative determinants of the primary outcome, using multivariable logistic regression analysis, the presence of age greater than 60 years, preoperative kidney dysfunction, and intraoperative red blood cell transfusion.

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Giant Benign Pericardial Cyst

Sónia Canadas et al. Rita Fernandes Luísa Gonçalves Inês Almeida Ana Vera-Cruz

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Percutaneous Management of Iatrogenic Aortocoronary Dissection Complicating Diagnostic Angiography or Percutaneous Coronary Intervention

Liang Tang et al. Xin-qun Hu Jian-jun Tang Sheng-hua Zhou Zhen-fei Fang

Introduction

Aortocoronary dissection is an infrequent, yet potentially catastrophic complication of coronary angiography (CAG) or percutaneous coronary intervention (PCI) that can lead to emergency surgical aortic repair, coronary artery bypass graft surgery (CABG) or death.^, According to the extent of aortic root involvement, Dunning et al. proposed three classes of aortocoronary dissection: Class I for focal dissection limited to the sinus of Valsalva; Class II for dissection that propagated less than 40 mm to the ascending aorta; and Class III for dissection extending 40 mm or more to the ascending aorta. Management of this rare entity is still technically challenging and the optimal treatment of aortocoronary dissection complicating CAG or PCI had not been clearly established. In this article, we describe a case series of aortocoronary dissection among consecutive diagnostic CAG and PCI procedures, which were successfully treated by coronary ostial stenting.

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Review Article

Acute myocardial infarction after noncardiac surgery

Danielle Menosi Gualandro et al. Daniela Calderaro Pai Ching Yu Bruno Caramelli

Over 230 million surgeries are performed annually worldwide, cardiac complications being the most common causes of postoperative morbidity and mortality. As life expectancy has extended worldwide, a growing number of patients with multiple comorbidities have undergone noncardiac surgeries. Consequently, cardiovascular complications associated with those procedures are expected to increase, and perioperative acute myocardial infarction (AMI) might become a frequent problem. In Brazil, the number of noncardiac surgical procedures has also increased, and approximately three million surgeries are performed annually. Despite advances in surgical and anesthetic techniques, mortality and costs related to those procedures have also increased, thus, requiring the development of strategies to reduce mortality4. The occurrence of perioperative AMI prolongs the need for intensive care and the hospital length of stay, increases the cost of hospitalization, and reduces long-term survival. This literature review approaches the pathophysiology, incidence, diagnosis and treatment of perioperative AMI based on current evidence.

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Original Article

Predictive factors of complications after coronary stent implantation

Alexandre Schaan de Quadros et al. Carlos A. M. Gottschall Rogério Sarmento-Leite Miguel Gus … Rodrigo Wainstein André Bussmann

OBJECTIVE: To analyze the predictive factors of complications after implantation of coronary stents in a consecutive cohort study. METHODS: Clinical and angiographic characteristics related to the procedure were analyzed, and the incidence of major cardiovascular complications (myocardial infarction, urgent surgery, new angioplasty, death) in the in-hospital phase were recorded. Data were stored in an Access database and analyzed by using the SPSS 6.0 statistical program and a stepwise backwards multiple logistic regression model. RESULTS: One thousand eighteen (mean age of 61±11 years, 29% females) patients underwent 1,070 stent implantations. The rate of angiographic success was 96.8%, the rate of clinical success was 91%, and the incidence of major cardiovascular complications was 7.9%. The variables independently associated with major cardiovascular complications, with their respective odds ratio (OR) were: rescue stent, OR = 5.1 (2.7-9.6); filamentary stent, OR = 4.5 (2.2-9.1); first-generation tubular stent, OR = 2.4 (1.2-4.6); multiple stents, OR = 3 (1.6-5.6); complexity of the lesion, OR = 2.4 (1.1-5.1); thrombus, OR = 2 (1.1-3.5). CONCLUSION: The results stress the importance of angiographic variables and techniques in the risk of complications and draw attention to the influence of the stent’s design on the result of the procedure.

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Registries and Evidence-Based Medicine

Giant Benign Pericardial Cyst

Percutaneous Management of Iatrogenic Aortocoronary Dissection Complicating Diagnostic Angiography or Percutaneous Coronary Intervention

Introduction

Acute myocardial infarction after noncardiac surgery

Predictive factors of complications after coronary stent implantation

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