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Angina instável : relação entre uma classificação clínica e os achados da cineangiocoronariografia

By Jose Antonio Silva

Abstract

Orientador: Prof. Dr. Paulo Franco de OliveiraDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Clínica Cirúrgica. Defesa: Curitiba, 25/11/1996Bibliografia: fls. 105-113Resumo: Com o objetivo de relacionar a classificação clínica da angina instável, proposta por Braunwald (1989), com os achados da cineangiocoronariografia, foram estudos 100 pacientes. A investigação foi desenvolvida na Unidade Coronariana do Hospital Cajuru, PUC - Paraná entre novembro/1994 e junho/1996. Todos pacientes foram classificados de acordo com: 1. Gravidade (classe I - angina progressiva e de início recente, 15 pacientes; classe II - angina de repouso, subaguda, 26 pacientes; classe III - angina de repouso, aguda, 59 pacientes). 2.Circunstância clínica (classe A - angina secundária, 2 pacientes; classe B - angina primária, 89 pacientes; classe C - angina pós infarto do miocárdio, 9 pacientes). 3. Tratamento: 3.a. tratamento inicial (mínimo ou sem tratamento, 68 pacientes; convencional, 30 pacientes; máximo, 2 pacientes). 3.b. tratamento evolutivo (mínimo, 36 pacientes; convencional, 55 pacientes; máximo, 9 pacientes). 4. Alterações de ST-T no eletrocardiograma (presença, 73 pacientes; ausência, 27 pacientes). Os achados cineangiocoronariográficos mostraram que as lesões culpadas estavam, localizadas mais freqüentemente (61%), no território da artéria descendente anterior e seus ramos. Todas as lesões culpadas eram críticas > 70%, sem haver oclusão total. Fluxo TIMI 70%) there were no total occlusions. TIMI - Flow <3 occurred in 36 patients: Class I, 5 of 15 patients (33,3%); Class II, 4 of 26 (15,4%) and Class III, 27 of 59 (45,8%) Intracoronary thrombus was observed in 21 patients: Class I, 2 of 15 patients (13,3%); Class II, 2 of 26 (7,7%) and 17 of 59 (28,8%) of Class III. Thrombus was observed in 16 of 89 patients (18%) of class B and in 5 of 9 (55,5%) of class C. In relation to the sequential treatment 12 of 36 (33,3%); patients with intensity 1, 18 of 55 (32,7%) with intensity 2, and 7 of 9 (77,7%) with intensity 3 had complex lesions. Concentric stenosis were observed in 57 of the totality of patients eccentric stenosis in 43, and very eccentric in 10. Smooth lesions were present in 53 patients and irregular lesions 45. Plaque fissuring was observed in 1 patient, ulcerated plaque in 5, plaque dissection in 2 and calcification in 16. The distribution of the frequency of the different types of lesion, according to Ambrose's classification, was: concentric stenosis, 45%; Type I eccentric lesions, 18 %; Type II eccentric lesion, 16% and multiple irregularities in 21%. The statistical analysis of the relation between the Brawnwald classification and the angiographic findings showed the dependence of the following variables: 1. Severity of the angina (Classes I, II and III and TIMI < 3, p = 0,0262). 2. Severity of the angina (Classes II and III and TIMI < 3, p = 0,007) 3. Severity of the angina (Classes II and III and thrombus, p= 0,0313), 4. Intensity of the sequential treatment and the presence of complex lesions ( Type II eccentric lesions and multiple irregularities, p = 0,293), 5. Clinical circumstances of the angina (Classes B and C and thrombus, p = 0,0202). The Conclusion was that the Braunwald classification of unstable angina provides useful information to the management of these patients, showing a relation between the clinical data and the cinecoronariography findings

Topics: Teses, Angina instavel, Coronariografia, Arterias coronarias, Placa aterosclerótica, Eletrocardiograma
Year: 1996
OAI identifier: oai:dspace.c3sl.ufpr.br:1884/29817

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