Fatores de risco e aspectos anatômicos da doença arterial coronariana : experiência de 30 anos

Abstract

Neste artigo apresentamos os trabalhos que desenvolvemos sobre os fatores de risco da doença arterial coronária. No primeiro trabalho, demonstramos que os pacientes que desenvolviam hemibloqueio anterior esquerdo durante um evento isquêmico agudo tinham doença obstrutiva grave em 3 artérias coronárias. No segundo trabalho, realizado em Syracuse, NY, USA demonstramos que 60% dos pacientes que se submetiam a cinecoronariografia não tinham sintomas antes do infarto do miocárdio, achados confirmados em estudo posterior em pacientes de Porto Alegre. Constatamos posteriormente que a presença de circulação colateral não tem relação com nenhum fator de risco, mas têm uma relação estatisticamente significativa com o grau de obstrução arterial coronária. Em outro estudo, demonstramos que os pacientes com triglicerídeos elevados tinham maior gravidade de doença do que os pacientes com colesterol elevado; os pacientes com colesterol e triglicerídeos elevados tinham maior severidade da doença do que os pacientes com aumento isolado de um deles. Em pacientes submetidos à cinecoronariografia, demonstramos que não existe relação entre doença arterial coronária e lesões de fundo de olho. Em outro estudo demonstramos que pacientes acometidos de infarto do miocárdio apresentam maior número de oclusões e maior extensão da doença arterial coronária do que pacientes que se apresentam com angina. Em outro estudo demonstramos que os pacientes submetidos à cinecoronariografia, as dosagens de apolipoproteínas AI e B não têm vantagem para identificar risco coronariano em relação às dosagens das lipoproteínas e seu custo é muito mais elevado. Finalmente, demonstramos uma relação entre maior concentração de ferritina com LDL aumentada e gravidade da doença arterial coronária.

In this article we present our contribution concerning risk factors in coronary artery disease. In the first study, we demonstrated that patients who developed left anterior hemiblock during acute ischemic events had severe coronary artery disease. In the second study, also conducted in Syracuse (USA, we showed that 60% of patients who were submited to coronary arteriography did not have symptoms before myocardial infarction, a finding later confirmed in a subsequent study in Porto Alegre. We observed that collaterals have no relationship with any risk factor, but had a significant association with the degree of coronary artery obstruction. In another study we demonstrated that patients with elevated triglycerides had a more severe condition of the disease than the ones whose cholesterol was elevated. Patients with elevated cholesterol and triglycerides had a more severe condition of the disease than patients with a single elevated one. In a jointwork with the Ophtalmology Department of HCPA relating coronary artery disease and fundoscopy findings, we showed there is no relationship between coronary artery disease and eyeground lesion. Aiming at the analysis of the relationship between coronary artery damage, risk factors and patients with myocardial infarction and other forms of clinic presentation, we compared 56 patients with myocardial infarction and 129 patients with chest angina. Results showed that patients with infaction had a more elevated number of occlusionand more extensive coronary artery disease. Smoking was the only significative risk factor for myocardial infarction. In order to identify the value and cost of the new risk factor for coronary arterial disease we studied the concentration of Apolipoprotein (APO-AI) and B (APO-B) in 241 patients submitted to cinecoronarygraphy. Results showed that dosages of Apolipoprotein A and B have no advantage over dosage of lipoprotein and its cost is much higher. More recently, following the same investigation line, we studied the relationship between ferritin concentration and severity of coronary artery disease in 307 patients submitted to coronary arteriography. Results evidenced the relationship between more elevated concentration of ferritin and increased LDL and severity of coronary artery disease. However, a multivaried analysis showed that ferritin isolated has no relationship with coronary atherosclerosis.