IJCS | Volume 32, Nº2, May/June 2019

218 Lobato et al. Patients undergoing cagb in Pará, Brazil Int J Cardiovasc Sci. 2019;32(3)217-226 Original Article evaluated. The study involved 17 centers from four Brazilian regions (the North regionwas not included). Of all procedures, 83%were performed in public or private hospitals of the Brazilian Unified Health System (SUS). MRS accounted for 48.8% of the procedures, with a 7-day mortality of 2.6%. 13 In the state of Pará, Brazil, 341 MRSs were performed in 2014, with a mortality rate of 7.0%. Of these surgeries, 46.0% were conducted at Fundação Hospital de Clínicas Gaspar Vianna (FHCGV) (city of Belem, Para), the main public center for treatment of cardiovascular diseases of Amazonia, with documented institutional death of 10.8%. 2 Today, nearly 50% of all MRSs carried out in the public system of Para state are conducted at FHCGV. 2 Considering that current recommendations of guidelines of cardiology societies are based on clinical trials performed in American and European institutions, it is urgently necessary, for scientific knowledge and healthcare administration, to verify whether the global evidence can be reproduced to the Amazonian population, considering preoperative conditions, previous comorbidities, severity of underlying disease and postoperative course. The aimof this studywas to describe the clinical course of patients undergoingMRS at the largest, referral public cardiology center in the Brazilian Amazon. Methods Study design and selection of patients This is an observational study, with analysis of a retrospective cohort from a historical series of patients who had undergone MRS at Fundação Hospital de Clínicas Gaspar Vianna from January 2013 to June 2014. The study was approved by the ethics committee of this institution. The study population was composed of adult patients (> 18 years old) who had undergone MRS. Patients who had undergone MRS combined with valvuloplasty or valve replacement, repair of congenital heart defects or aortic surgery were excluded from the study. We also excluded patients whose medical records were not located, had illegible handwriting, or whose data were unavailable for any reason. Data collection Data were collected from medical records using a standard half-open questionnaire of clinical and demographic characteristics of the study population. We collected all data registered from hospital admission to outpatient follow-up, until one year of the procedure. Clinical outcomes Main outcome was postoperative mortality from the admission day until one year after the procedure. Secondary outcomes were the following surgical complications – need for hemodialysis, major bleeding (as defined in the medical records), need for blood transfusion, cardiogenic shock and hospital infection. Statistical analysis The Kolmogorov-Smirnov test was used to verify the normality of distribution of continuous variables, expressed as mean ± standard deviation. Categorical variables were described as frequency and percentage, and respective 95% confidence interval. Differences in the occurrence of the variables were evaluated by the chi-square test. For mortality-related variables, odds ratio analysis was performed, with confidence interval of 95%. For all statistical tests, a p < 0.05 was set as statistically significant. Statistical processing of the data was performed using the IBM SPSS Statistics Client for Trial 21.0 Mac OS Multilingual ® . Results A total of 179 medical records of patients of both sexes who had undergone elective and urgent MRS were analyzed. All patients were submitted to extracorporeal circulation. Due to characteristics of our institution, as compared with the assistance provided by other public hospitals in which MRS is also performed, located in southern Para state, all patients underwent MRS after an episode of acute coronary syndrome (ST segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction or unstable angina). Despite this, only 7.8% of patients underwent urgent surgery and 92.2% to elective procedure. Mean age of patients was 62.1 ± 9.2 years; most patients were aged between 60 and 70 years (45.8%), followed by 50-60 years (24.6%) and older than 70 years (19.0%). Most patients were male (74.9%) and originated from the capital and metropolitan area (65.4%) (Table 1).