Paulo R. Soares
University of São Paulo
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Featured researches published by Paulo R. Soares.
Circulation | 2007
Whady Hueb; Neuza Lopes; Bernard J. Gersh; Paulo R. Soares; Expedito E. Ribeiro; Alexandre C. Pereira; Desiderio Favarato; Antonio Sérgio C. Rocha; Alexandre Ciappina Hueb; José Antonio Franchini Ramires
Background— Despite routine use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), no conclusive evidence exists that either modality is superior to medical therapy (MT) alone for treating multivessel coronary artery disease with stable angina and preserved ventricular function. Methods and Results— The primary end points were total mortality, Q-wave myocardial infarction, or refractory angina requiring revascularization. The study comprised 611 patients randomly assigned to undergo CABG (n=203), PCI (n=205), or MT (n=203). At the 5-year follow-up, the primary end points occurred in 21.2% of patients who underwent CABG compared with 32.7% treated with PCI and 36% receiving MT alone (P=0.0026). No statistical differences were observed in overall mortality among the 3 groups. In addition, 9.4% of MT and 11.2% of PCI patients underwent repeat revascularization procedures compared with 3.9% of CABG patients (P=0.021). Moreover, 15.3%, 11.2%, and 8.3% of patients experienced nonfatal myocardial infarction in the MT, PCI, and CABG groups, respectively (P<0.001). The pairwise treatment comparisons of the primary end points showed no difference between PCI and MT (relative risk, 0.93; 95% confidence interval, 0.67 to 1.30) and a significant protective effect of CABG compared with MT (relative risk, 0.53; 95% confidence interval, 0.36 to 0.77). Conclusions— All 3 treatment regimens yielded comparable, relatively low rates of death. MT was associated with an incidence of long-term events and rate of additional revascularization similar to those for PCI. CABG was superior to MT in terms of the primary end points, reaching a significant 44% reduction in primary end points at the 5-year follow-up of patients with stable multivessel coronary artery disease.
Circulation | 2010
Whady Hueb; Neuza Lopes; Bernard J. Gersh; Paulo R. Soares; Expedito E. Ribeiro; Alexandre C. Pereira; Desiderio Favarato; Antonio Sérgio C. Rocha; Alexandre Ciappina Hueb; José Antonio Franchini Ramires
Background— This study compared the 10-year follow-up of percutaneous coronary intervention (PCI), coronary artery surgery (CABG), and medical treatment (MT) in patients with multivessel coronary artery disease, stable angina, and preserved ventricular function. Methods and Results— The primary end points were overall mortality, Q-wave myocardial infarction, or refractory angina that required revascularization. All data were analyzed according to the intention-to-treat principle. At a single institution, 611 patients were randomly assigned to CABG (n=203), PCI (n=205), or MT (n=203). The 10-year survival rates were 74.9% with CABG, 75.1% with PCI, and 69% with MT (P=0.089). The 10-year rates of myocardial infarction were 10.3% with CABG, 13.3% with PCI, and 20.7% with MT (P<0.010). The 10-year rates of additional revascularizations were 7.4% with CABG, 41.9% with PCI, and 39.4% with MT (P<0.001). Relative to the composite end point, Cox regression analysis showed a higher incidence of primary events in MT than in CABG (hazard ratio 2.35, 95% confidence interval 1.78 to 3.11) and in PCI than in CABG (hazard ratio 1.85, 95% confidence interval 1.39 to 2.47). Furthermore, 10-year rates of freedom from angina were 64% with CABG, 59% with PCI, and 43% with MT (P<0.001). Conclusions— Compared with CABG, MT was associated with a significantly higher incidence of subsequent myocardial infarction, a higher rate of additional revascularization, a higher incidence of cardiac death, and consequently a 2.29-fold increased risk of combined events. PCI was associated with an increased need for further revascularization, a higher incidence of myocardial infarction, and a 1.46-fold increased risk of combined events compared with CABG. Additionally, CABG was better than MT at eliminating anginal symptoms. Clinical Trial Registration Information— URL: http://www.controlled-trials.com. Registration number: ISRCTN66068876.
Circulation | 2010
Whady Hueb; Neuza Lopes; Alexandre C. Pereira; Alexandre Ciappina Hueb; Paulo R. Soares; Desiderio Favarato; Ricardo D Vieira; Eduardo Gomes Lima; Cibele Larrosa Garzillo; Felipe da Silva Paulitch; Luiz Antonio Machado César; Bernard J. Gersh; José Antonio Franchini Ramires
Background— Coronary artery bypass graft surgery with cardiopulmonary bypass is a safe, routine procedure. Nevertheless, significant morbidity remains, mostly because of the bodys response to the nonphysiological nature of cardiopulmonary bypass. Few data are available on the effects of off-pump coronary artery bypass graft surgery (OPCAB) on cardiac events and long-term clinical outcomes. Methods and Results— In a single-center randomized trial, 308 patients undergoing coronary artery bypass graft surgery were randomly assigned: 155 to OPCAB and 153 to on-pump CAB (ONCAB). Primary composite end points were death, myocardial infarction, further revascularization (surgery or angioplasty), or stroke. After 5-year follow-up, the primary composite end point was not different between groups (hazard ratio 0.71, 95% CI 0.41 to 1.22; P=0.21). A statistical difference was found between OPCAB and ONCAB groups in the duration of surgery (240±65 versus 300±87.5 minutes; P<0.001), in the length of ICU stay (19.5±17.8 versus 43±17.0 hours; P<0.001), time to extubation (4.6±6.8 versus 9.3±5.7 hours; P<0.001), hospital stay (6±2 versus 9±2 days; P<0.001), higher incidence of atrial fibrillation (35 versus 4% of patients; P<0.001), and blood requirements (31 versus 61% of patients; P<0.001), respectively. The number of grafts per patient was higher in the ONCAB than the OPCAB group (2.97 versus 2.49 grafts/patient; P<0.001). Conclusions— No difference was found between groups in the primary composite end point at 5-years follow-up. Although OPCAB surgery was related to a lower number of grafts and higher episodes of atrial fibrillation, it had no significant implications related to long-term outcomes. Clinical Trial Registration— URL: http://www.controlled-trials.com. Unique identifier: ISRCTN66068876.
Circulation | 2006
Paulo R. Soares; Whady Hueb; Pedro A. Lemos; Neuza Lopes; Eulógio E. Martinez; Luis Antonio Machado Cesar; Sérgio Almeida de Oliveira; José Antonio Franchini Ramires
Background— It is currently unknown whether revascularization procedures are associated with an improvement in mortality among diabetic subjects, as compared with a more conservative medical treatment. Methods and Results— In MASS II, a total of 611 patients with stable multivessel coronary disease were randomly assigned to medical treatment, surgery, or angioplasty. From these, 190 patients had diabetes (medical, 75 patients; angioplasty, 56 patients; surgery, 59 patients) and comprised the present study population. Mortality rates were analyzed for the entire 5 years of follow-up. Separate analyzes were also performed for mortality at 2 time intervals: during the first year and after the first year of follow-up. We calculated the probability of death conditional on surviving to the start of the interval analyzed. The cumulative 5-year mortality as well as the mortality during the first year of follow-up was not significantly different among treatment groups, both for diabetic and for nondiabetic subjects. Also, during years 2 to 5, the mortality of the 3 treatment groups was not different for nondiabetic subjects. Among diabetic subjects, however, patients randomized to angioplasty or surgery had a significantly lower mortality between years 2 and 5 than those allocated to medical treatment (P=0.039). Conclusion— Surgery, angioplasty, and medical treatment appear to be associated with similar mortality rates for non-diabetic subjects. For diabetic subjects, however, coronary revascularization (percutaneous or surgical) significantly decreased the risk of death after the first year and up to 5 years, compared with medical treatment alone.
Circulation | 2003
Desiderio Favarato; Whady Hueb; Bernard J. Gersh; Paulo R. Soares; Luiz Antonio Machado César; Protásio Lemos da Luz; Sérgio Almeida de Oliveira; José Antonio Franchini Ramires
Background—Prior comparisons of costs following CABG and PTCA have demonstrated higher initial costs after CABG but following PTCA, recurrent symptoms and repeat revascularization result in increased late costs and over time their costs equilibrate. The MASS II trial provides an opportunity to compare the costs of CABG and PTCA in addition to a strategy of medical therapy. Methods—We studied the 611 patients of MASS II [Medical (203), Angioplasty (205), or Surgery (203) Study], a randomized study to compare treatments for multivessel CAD and preserved left ventricle function. The costs were: CABG US
Jacc-cardiovascular Interventions | 2014
José Mariani; Cristiano Guedes; Paulo R. Soares; Silvio Zalc; Carlos M. Campos; Augusto C. Lopes; André Gasparini Spadaro; Marco Antonio Perin; Antonio Esteves Filho; Celso Kiyochi Takimura; Expedito E. Ribeiro; Roberto Kalil-Filho; Elazer R. Edelman; Patrick W. Serruys; Pedro A. Lemos
10 650.00; PTCA US
Circulation | 2012
Ricardo D Vieira; Whady Hueb; Bernard J. Gersh; Eduardo Gomes Lima; Alexandre C. Pereira; Paulo Cury Rezende; Cibele Larrosa Garzillo; Alexandre Ciappina Hueb; Desiderio Favarato; Paulo R. Soares; José Antonio Franchini Ramires; Roberto Kalil Filho
6400.00; new AMI hospitalization AMI U
American Heart Journal | 2013
Eduardo Gomes Lima; Whady Hueb; Rosa Maria Rahmi Garcia; Alexandre C. Pereira; Paulo R. Soares; Desiderio Favarato; Cibele Larrosa Garzillo; Ricardo D Vieira; Paulo Cury Rezende; Myrthes Emy Takiuti; Priscyla Girardi; Alexandre Ciappina Hueb; José Antonio Franchini Ramires; Roberto Kalil Filho
2550; angiography not followed-up of PTCA US
Annals of Noninvasive Electrocardiology | 2005
Beatriz Moreira Ayub Ferreira; Paulo Jorge Moffa; Andréa Falcão; Augusto Hiroshi Uchida; Paulo Roberto Camargo; Pascual Luis Angel Pereyra; Paulo R. Soares; Whady Hueb; José Antonio Franchini Ramires
1900.00; and medication US
Heart | 2004
Chi-Hang Lee; P. J. De Feyter; P. W. Serruys; Francesco Saia; Pedro A. Lemos; Dick Goedhart; Paulo R. Soares; Victor A. Umans; Marco Matteo Ciccone; M Cortellaro
1200.00 for medical, and US