Angioplastia Primária na Mulher: Realidade Nacional

Objetivos: A mortalidade na mulher após angioplastia primária (ICP-P) é superior à do homem. Contudo, permanece contraditório o papel do sexo poder ser fator de risco independente para mortalidade no contexto de enfarte agudo do miocárdio com supradesnivelamento de ST (EAMST). Com base no Registo Nacional de Cardiologia de Intervenção (RNCI),pretendemos avaliar como é que o género feminino influencia o prognóstico a curto prazo nos doentes com EAMST submetidos a ICP-P a nível nacional. Métodos: De 60 158 doentes incluídos prospetivamente no RNCI de 2002-2012, incluímos na análise 7544 doentes com EAMST tratados por ICP-P, dos quais 25% foram mulheres. Utilizámos modelos de regressão logística e ajustamento por propensity score para avaliar o impacto do sexo na mortalidade hospitalar. Resultados: As mulheres foram mais idosas (68 ± 14 versus 61 ± 13, p < 0,001), mais diabéticas(30 versus 21%, p < 0,001) e hipertensas (69 versus 55%, p < 0,001). Os homens foram revascularizados mais cedo (71 versus 63% nas primeiras 6 horas, p < 0,001). Choque cardiogénico foi mais frequente nas mulheres (7,1 versus 5,7%, p = 0,032). Estas apresentaram um pior prognóstico a curto prazo, com 1,7 x maior risco de morte intra-hospitalar (4,3 versus 2,5%; IC 95% 1,30-2,27; p < 0,001). Utilizando um modelo de regressão ajustado através de um propensity score, o sexo deixa de ser preditor de mortalidade hospitalar (OR 1,00; IC 95% 0,68-1,48; p = 1,00). Conclusões: No RNCI as mulheres com EAMST tratadas com ICP-P apresentaram maior risco cardiovascular, um acesso menos atempado a ICP-P e um pior prognóstico. Contudo, após ajustamento do risco, o género feminino deixa de ser preditor independente de mortalidade hospitalar.

American Society of Anesthesiologists Score: Still Useful After 60 Years? Results of the EuSOS Study

OBJECTIVE: The European Surgical Outcomes Study described mortality following in-patient surgery. Several factors were identified that were able to predict poor outcomes in a multivariate analysis. These included age, procedure urgency, severity and type and the American Association of Anaesthesia score. This study describes in greater detail the relationship between the American Association of Anaesthesia score and postoperative mortality. METHODS: Patients in this 7-day cohort study were enrolled in April 2011. Consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery with a recorded American Association of Anaesthesia score in 498 hospitals across 28 European nations were included and followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Decision tree analysis with the CHAID (SPSS) system was used to delineate nodes associated with mortality. RESULTS: The study enrolled 46,539 patients. Due to missing values, 873 patients were excluded, resulting in the analysis of 45,666 patients. Increasing American Association of Anaesthesia scores were associated with increased admission rates to intensive care and higher mortality rates. Despite a progressive relationship with mortality, discrimination was poor, with an area under the ROC curve of 0.658 (95% CI 0.642 - 0.6775). Using regression trees (CHAID), we identified four discrete American Association of Anaesthesia nodes associated with mortality, with American Association of Anaesthesia 1 and American Association of Anaesthesia 2 compressed into the same node. CONCLUSION: The American Association of Anaesthesia score can be used to determine higher risk groups of surgical patients, but clinicians cannot use the score to discriminate between grades 1 and 2. Overall, the discriminatory power of the model was less than acceptable for widespread use.