Preditores independentes de doença arterial coronária multiarterial: resultados do Registro Angiocardio

Abstract

Introdução

O Registro Angiocardio, que agrega dados de cinco diferentes centros do Estado de São Paulo, oferece a oportunidade de estudar a associação de fatores de risco cardiovasculares com a extensão da doença arterial coronária (DAC), avaliada pela cinecoronariografia. Este estudo buscou analisar preditores independentes de DAC multiarterial em nosso meio.

Métodos

De agosto de 2006 a janeiro de 2014, 16.320 pacientes com DAC foram incluídos e divididos nos grupos uni e multiarterial.

Resultados

Pacientes multiarteriais (n = 9.512, 58,3%) apresentaram‐se, em média, 3 anos mais idosos, com maior prevalência do sexo masculino (69,4% vs. 65,4%; p < 0,01), hipertensão arterial (80,0% vs. 73,5%; p < 0,01), diabetes (40,7% vs. 28,8%; p < 0,01), dislipidemia (39,6% vs. 34,9%; p < 0,01), antecedentes familiares de DAC precoce (23,0% vs. 21,3%; p < 0,01), insuficiência renal crônica (4,1% vs. 2,6%; p < 0,01), acidente vascular cerebral prévio (3,8% vs. 2,8%; p < 0,01), doença vascular periférica (4,0% vs. 3,3%; p = 0,02) e infarto do miocárdio prévio (18,4% vs. 13,9%; p < 0,01), além de menor prevalência de tabagismo (20,0% vs. 24,5%; p < 0,01). À análise multivariada, foram preditores independentes de lesão multiarterial idade > 40 anos (odds ratio ‐ OR = 1,996; IC 95% 1,52‐2,63; p < 0,01), sexo masculino (OR = 1,202; IC 95% 1,12‐1,28; p < 0,01), hipertensão arterial (OR = 1,439; IC 95% 1,34‐1,55; p < 0,01), diabetes (OR = 1,697; IC 95% 1,59‐1,81; p < 0,01), dislipidemia (OR = 1,223; IC 95% 1,15‐1,30; p < 0,01), infarto agudo do miocárdio prévio (OR = 1,393; IC 95% 1,28‐1,52; p < 0,01) e insuficiência renal crônica (OR = 1,597; IC 95% 1,33‐1,91; p < 0,01).

Conclusões

A DAC multiarterial em nosso meio é associada aos fatores de risco tradicionais para aterosclerose, com exceção do tabagismo. A idade, o diabetes e a insuficiência renal crônica foram os fatores preditores mais fortes para a DAC multiarterial avaliada pela cinecoronariografia.

Background

The Angiocardio Registry, which comprises data from five different centers in the state of São Paulo, offers the opportunity to study the association between cardiovascular risk factors and coronary artery disease (CAD) extent, as assessed by coronary angiography. This study aimed to evaluate independent predictors of multivessel CAD in Brazil.

Methods

From August 2006 to January 2014, 16,320 patients with CAD were included and divided into the single‐ and multivessel groups.

Results

Patients with multivessel disease (n = 9,512, 58.3%) were on average 3 years older, with a higher prevalence of males (69.4% vs. 65.4%; p < 0.01), arterial hypertension (80.0% vs. 73.5%; p < 0.01), diabetes (40.7% vs. 28.8%; p < 0.01), dyslipidemia (39.6% vs. 34.9%; p < 0.01), family history of CAD (23.0% vs. 21.3%; p < 0.01), chronic renal failure (4.1% vs. 2.6%; p < 0.01), previous stroke (3.8% vs. 2.8%; p < 0.01), peripheral vascular disease (4.0% vs. 3.3%; p = 0.02) and previous myocardial infarction (18.4% vs. 13.9%; p < 0.01), as well as a lower prevalence of smoking (20.0% vs. 24.5%; p < 0.01). At the multivariate analysis, the following were independent predictors of multivessel lesion: age > 40 years (odds ratio ‐ OR = 1.996; 95% CI: 1.52‐2.63; p < 0.01), male gender (OR = 1.202; 95% CI: 1.12‐1.28; p < 0.01), arterial hypertension (OR = 1.439; 95% CI: 1.34‐1.55; p < 0.01), diabetes (OR =1.697; 95% CI: 1.59‐1.81; p < 0.01), dyslipidemia (OR = 1.223; 95% CI: 1.15‐1.30; p < 0.01), previous acute myocardial infarction (OR = 1.393; 95% CI: 1.28‐1.52; p < 0.01), and chronic renal failure (OR = 1.597; 95% CI: 1.33‐1.91; p < 0.01).

Conclusions

Multivessel CAD in Brazil is associated with traditional risk factors for atherosclerosis, except for smoking. Age, diabetes, and chronic renal failure were the strongest predictors for multivessel CAD assessed by coronary angiography.