IJCS | Volume 31, Nº2, March / April 2018

DOI: 10.5935/2359-4802.20180013 133 International Journal of Cardiovascular Sciences. 2018;31(2)133-142 ORIGINAL ARTICLE Mailing Address: Maria das Neves Dantas da Silveira Barros• Rua Cardeal Arcoverde, 85/1501 Bloco A. Postal Code: 52011-240, Graças, Recife, PE – Brazil. E-mail: mndantas@hotmail.com.br ; vweyden@gmail.com Predictors of Coronary Artery Obstructive Disease in Acute Pulmonary Edema of Unclear Origin Maria das Neves Dantas da Silveira Barros, 1,2,3 VanderWeydenBatista de Sousa, 2 IsabelleAdjanine Borges de Lima, 2 Cecília Raquel BezerraMarinhoNóbrega, 2 IsabelleConceiçãoAlbuquerqueMachadoMoreira, 2 SuzanaMarineMartinsDourado, 2 BrunaMaria Simões Andrade, 2 Virgínia da Silva Batista, 2 Maria Cleide Freire Clementino da Silva, 2 Luís Cláudio Correia 1 Escola Bahiana de Medicina e Saúde Pública - EBMSP, 1 Salvador, BA; Pronto-Socorro Cardiológico de Pernambuco/Universidade de Pernambuco - Procape/UPE; 2 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior/ Programa de Doutorado Sanduíche no Exterior CAPES/PDSE, 3 – Brazil Manuscript received November 27, 2016, revised manuscript August 08, 2017, accepted August 21, 2017 Abstract Background: Cardiogenic Acute Pulmonary Edema (APE) is considered one of the main medical emergencies, and it is the extreme manifestation of acute heart failure. The main etiology of heart failure is ischemic heart disease. To date, the definition of ischemic etiology in acute pulmonary edema was based on criteria such as: clinical history of ischemic heart disease, noninvasive examinations and, in other patients, coronary angiography. Classified as such, ischemic heart disease has been shown to be its main etiology. The high prevalence between these two diseases was evaluated, but not by the exclusive angiographic criterion, the gold standard of this pathology and the reason of this study. Objective: To evaluate the predictors of obstructive coronary artery disease in patients with acute pulmonary edema of unclear origin. Method: Patients admitted to a cardiovascular disease referral emergency unit were recruited to undergo coronary angiography if the acute pulmonary edema etiology was not adequately elucidated. Obstructive coronary disease was considered if at least one epicardial vessel had 70% of occlusion. Results: Obstructive coronary disease was classified by coronary angiography in 149 consecutively evaluated patients, and coronary artery obstruction was the outcome variable of the predictor model. Among the variables related to coronary disease, the predictor variables were the history of coronary artery disease (p < 0.001) and myocardium segmental deficit at the echocardiogram (p < 0.02). Conclusion: The antecedent of coronary disease and the myocardium segmental deficit at the echocardiogram were able to discriminate patients with acute pulmonary edema associated with obstructive coronary disease. Troponin values classified by two cardiologists as secondary to an acute non-ST-segment elevation myocardial infarction, and chest pain preceding the clinical picture were not able to discriminate patients with or without coronary obstruction and thus, the diagnosis of obstructive coronary disease should not be pursued based on the troponin value and/or chest pain preceding the clinical picture. (Int J Cardiovasc Sci. 2018;31(2)133-142) Keywords: Heart Failure; Pulmonary Edema; Coronary Artery Disease; Risk Factors; Myocardial Ischemia. Introduction Acute Pulmonary Edema (APE) is the extreme expression of acute heart failure (HF) in the emergency room, being classified as cardiogenic (APE) or non‑cardiogenic (Acute Respiratory Distress Syndrome – ARDS). The etiology and pathophysiological mechanisms differ between them. The first occurs due to the increase in hydrostatic pressure within the pulmonary capillary, and the second type is a consequence of the increased permeability of the alveolar-capillary membrane. It is important to consider the clinical history to identify each of these types, as the diseases related to each type are well recognized; however, misdiagnosis can occur due to the coexistence of diseases in the same clinical scenario. APE corresponds to the second highest hospital