Multicenter Studies – ABC CARDIOL

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Special Article

One year follow-up Assessment of Patients Included in the Brazilian Registry of Acute Coronary Syndromes (ACCEPT)

Pedro Gabriel Melo de Barros e Silva et al. Otavio Berwanger Elizabete Silva dos Santos Antônio Carlos Sobral Sousa … Margaret Assad Cavalcante Pedro Beraldo de Andrade Fernando Carvalho Neuenschwander Hugo Vargas Filho Jorge Ilha Guimarães Jadelson Andrade Angelo Amato Vincenzo de Paola Marcus Vinicius Bolivar Malachias Luiz Alberto Piva e Mattos Dalton Bertolim Precoma Fernando Bacal Oscar Pereira Dutra

Abstract

Background

There is lack of prospective data on evolution within one year of acute coronary syndromes (ACS) in a representative population of Brazilian patients.

Objectives

To assess the prescription of evidence-based therapies, the incidence of severe outcomes and the predictors for these outcomes in a multicenter Brazilian registry of ACS patients.

Methods

The ACCEPT is a prospective observational study, which included patients hospitalized with a diagnostic of ACS in 47 Brazilian hospitals. The patients were followed for a 1 year and data were collected on the medical prescription and the occurrence of major cardiovascular events (cardiovascular mortality, reinfarction and cerebrovascular accident – CVA). Values of p < 0.05 were considered statistically significant.

Results

A total of 5,047 patients were included in this registry from August 2010 to April 2014. The diagnosis of ACS was confirmed in 4,782 patients (94.7%) and, among those, the most frequent diagnosis was ACS with ST segment elevation (35.8%). The rate of major cardiovascular events was 13.6 % within 1 year. Adherence to prescription of evidence-based therapy at admission was of 62.1%. Age, public service, acute myocardial infarction, CVA, renal failure, diabetes and quality of therapy were associated independently with the occurrence of major cardiovascular events.

Conclusions

During the one-year follow-up of the ACCEPT registry, more than 10% of the patients had major cardiovascular events and this rate ranged according with the quality of therapy. Strategies must be elaborated to improve the use of evidence-based therapies to minimize the cardiovascular events among the Brazilian population. (Arq Bras Cardiol. 2020; 114(6):995-1003)

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Original Article

Reproducibility of Left Ventricular Mass by Echocardiogram in the ELSA-Brasil

Alexandre Pereira Tognon et al. Murilo Foppa Vivian Cristine Luft Lloyd Ellwood Chambless … Paulo Lotufo Lilia Maria Mameri El Aouar Luciana Pereira Fernandes Bruce Bartholow Duncan

Background:

Echocardiography, though non-invasive and having relatively low-cost, presents issues of variability which can limit its use in epidemiological studies.

Objective:

To evaluate left ventricular mass reproducibility when assessed at acquisition (online) compared to when assessed at a reading center after electronic transmission (offline) and also when assessed by different readers at the reading center.

Methods:

Echocardiographers from the 6 ELSA-Brasil study investigation centers measured the left ventricular mass online during the acquisition from 124 studies before transmitting to the reading center, where studies were read according to the study protocol. Half of these studies were blindly read by a second reader in the reading center.

Results:

From the 124 echocardiograms, 5 (4%) were considered not measurable. Among the remaining 119, 72 (61%) were women, mean age was 50.2 ± 7.0 years and 2 had structural myocardial abnormalities. Images were considered to be optimal/ good by the reading center for 110 (92.4%) cases. No significant difference existed between online and offline measurements (1,29 g, CI 95% −3.60-6.19), and the intraclass correlation coefficient between them was 0.79 (CI 95% 0.71-0.85). For images read by two readers, the intraclass correlation coefficient was 0.86 (CI 95% 0.78-0.91).

Conclusion:

There were no significant drifts between online and offline left ventricular mass measurements, and reproducibility was similar to that described in previous studies. Central quantitative assessment of echocardiographic studies in reading centers, as performed in the ELSA-Brasil study, is feasible and useful in clinical and epidemiological studies performed in our setting.

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Special Article

Clinical outcomes at 30 days in the brazilian registry of acute coronary syndromes (ACCEPT)

Luiz A lberto Piva e Mattos et al. Otávio Berwanger Elizabete Silva dos Santos Helder José Lima Reis … Edson Renato Romano João Luiz Fernandes Petriz Antônio Carlos Sobral Sousa Fernando C. Neuenschwander Jorge Ilha Guimarães Jadelson Pinheiro de Andrade

BACKGROUND: There are few registries documenting clinical practice in Brazilian patients with acute coronary syndrome. OBJECTIVES: Demography description, occurrence of major clinical adverse events and comparative analysis in patients submitted or not to an invasive strategy (coronary angiography and myocardial revascularization) in a Brazilian multicenter registry of acute coronary syndrome. METHODS: The ACCEPT/SBC registry prospectively collected data on acute coronary syndrome patients from 47 Brazilian hospitals. The current analysis reports the occurrence of major clinical outcomes and according to the performance or not of a procedure for myocardial revascularization at the end of 30 day follow-up. RESULTS: Between August 2010 and December 2011, 2.485 patients were enrolled in this registry. Of these, 31.6% had unstable angina, 34.9% and 33.4% had acute coronary syndrome without and with ST-segment elevation. At 30 days, the performance of a myocardial revascularization procedure was progressively higher according to the severity of clinical presentation (38.7% vs. 53.6% vs. 77.7%, p < 0.001). Cardiac mortality among those submitted or not to myocardial revascularization procedure was 1.0% vs. 2.3% (p = 0.268), 1.9% vs. 4.2% (p = 0.070) and 2.0% vs. 8.1% (p < 0.001), in those with unstable angina, acute coronary syndrome without and with ST-segment elevation, respectively. CONCLUSIONS: The prescription of a myocardial revascularization procedure was progressively more frequent according to the severity of clinical presentation; for those treated during acute coronary syndrome without and with ST-segment elevation, there was a trend and significant decrease in mortality rate at 30 day of follow-up, respectively.

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Special Article

Rationality and methods of ACCEPT registry – Brazilian Registry of Clinical Practice in Acute Coronary Syndromes of the Brazilian Society of Cardiology

Luiz Alberto Piva e Mattos

BACKGROUND: Assessing the Brazilian clinical practice in patients with acute coronary syndrome, in public and private hospitals to identify gaps in the incorporation of clinical interventions with proven benefit. OBJECTIVE:To develop a registry of patients diagnosed with acute coronary syndrome to assess demographics, morbidity, mortality, and standard practice in the care of this condition. Besides, to assess the prescription of evidence-based interventions such as aspirin, statins, beta blockers and reperfusion, among others. METHODS: Registry-type prospective observational study intended to document hospital clinical practices of acute coronary syndrome in public and private hospitals in Brazil. In addition, longitudinal follow-up will be held until discharge and measurement of mortality and occurrence of serious events at 30 days, 6 and 12 months. RESULTS: The findings will be presented one year after the start of collection (September 2011), and consolidated after a meeting with the population to discuss the objectives sought. CONCLUSION: The analysis of this multicenter registry will design a horizontal perspective for the treatment of patients suffering from cardiovascular disease in Brazil.

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Special Article

Rationality and methods: registry of clinical practice in high-risk cardiovascular patients

Luiz Alberto Piva e Mattos

BACKGROUND: To date, no Brazilian registry has been designed to document the clinical practice regarding assistance to patients at high cardiovascular risk in a large representative sample of research centers, including public and private hospitals nationwide. Thus, this study will identify gaps in the incorporation of interventions with proven benefit in our area. OBJECTIVE: To record information on the Brazilian clinical practice with regard to the patients at high cardiovascular risk. METHODS: Registry-type prospective observational study intended to document the current clinical practice applied to outpatients at high cardiovascular risk classified by the presence of one of the following variables: evidence of coronary artery disease, cerebrovascular disease, peripheral vascular disease in diabetics or non-diabetics; or in the presence of at least three of the following cardiovascular risk factors: hypertension, active smoking, dyslipidemia, age over 70 years, chronic kidney disease, family history of coronary artery disease and/or asymptomatic carotid artery disease. Patients will be collected in 43 centers across Brazil, including public and private hospitals, as well as in basic health care units, and clinically reviewed for one year after inclusion. RESULTS: The findings will be presented one year after the start of collection (September 2011), and consolidated after a meeting with the population to discuss the objectives sought. CONCLUSION: The analysis of this multicenter registry will design a horizontal perspective for the treatment of patients suffering from cardiovascular disease in Brazil.

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Artigo Original

Clinical outcomes by geographic region for patients implanted with the zotarolimus-eluting stent

Chaim Lotan et al. Ian T. Meredith Ajay Jain Fausto Feres … A. Firszt A. Frutos Garcia Martin T. Rothman

BACKGROUND: Differences between geographic regions in patient characteristics and outcomes, particularly for acute coronary syndromes, have been demonstrated in clinical trials. Clinical outcomes after percutaneous coronary interventions with the Zotarolimus-eluting stent in a real-world population were assessed over time. OBJECTIVE: The influence of geographic location on clinical outcomes with the Zotarolimus-eluting stent was assessed in 3 regions: Asia Pacific, Europe, and Latin America. METHODS: A total of 8,314 patients (6,572 Europe, 1,522 Asia Pacific, and 220 Latin America) were followed for 1 year; 2,116 of these (1,613, 316, and 187, respectively) were followed for 2 years. Patient and lesion characteristics, dual antiplatelet therapy, and clinical outcomes were compared between Latin America and the other regions. RESULTS: Patients in Latin America had the highest proportions of risk factors and prior myocardial infarction. Dual antiplatelet therapy usage rapidly declined in Latin America, from 44.9% at 6 months to 22.5% at 1 year and 7.8% at 2 years (Europe: 87.4%, 61.5%, 19.7%; Asia Pacific: 82.4%, 67.0%, 45.7%). There were no significant differences between Latin America and Europe or Asia Pacific for any outcome at either time point. The incidence of Academic Research Consortium definite and probable stent thrombosis was low (<1.2%) among all patients at 1 year and 2 years. CONCLUSION: Clinical outcomes were comparable between patients in Latin America and Europe, and Latin America and Asia Pacific, despite less favorable clinical subsets in Latin America, a higher risk profile, and markedly lower use of dual antiplatelet therapy over time.

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