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Métodos estatísticos na avaliação do gradiente de pressão sistólica, da hipertensão e da medicação após implantação de stent por coartação da aorta
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Advisor(s)
Abstract(s)
Este estudo utilizou uma base de dados anonimizada, com 79 pacientes com coartação
da aorta nativa ou recorrente e que foram submetidos a implantação de stent. Trata-se
dum estudo retrospetivo, com dados clínicos colhidos de rotina. O principal objetivo foi
analisar os fatores que influenciam os resultados da intervenção, quer imediatos quer a
médio e longo prazo.
Uma primeira análise teve por objetivo encontrar os fatores que influenciam o valor do
gradiente de pressão sistólica, imediatamente após a implantação de stent. Recorreu-se
à regressão ordinal e concluiu-se que os fatores significativos são a hipoplasia do arco
transverso e o grau de estenose da aorta.
Numa segunda análise encontraram-se as variáveis que distinguem os pacientes
normotensos dos hipertensos, após implantação de stent, a médio e longo prazo. Foi
ajustado um modelo de regressão logística binária e concluiu-se que os fatores
significativos são a hipoplasia do arco transverso da aorta, o gradiente de pressão
sistólica antes da implantação do stent, a idade de implantação do 1º stent e o número
de anti-hipertensivos que o paciente tomava antes da intervenção.
Na terceira análise selecionaram-se apenas os pacientes que reduziram a medicação
após a implantação do stent e ajustou-se um modelo de regressão de Poisson. Concluiuse que a hipoplasia do arco transverso da aorta e a necessidade duma segunda
intervenção de dilatação do balão ou reimplantação de stent são preditores
significativos do número de fármacos anti-hipertensivos que o paciente necessita, a
médio e longo prazo.
This study used an anonymised database of 79 patients with native or recurrent aortic coarctation who underwent stent implantation. This is a retrospective study, with clinical data collected on a routine basis. The main objective was to analyse the factors influencing the immediate, mid-term and long-term results of the intervention. A first analysis aimed to find the factors that influence the value of the systolic pressure gradient, immediately after stent implantation. Ordinal regression has been used and it was concluded that the significant factors are transverse arch hypoplasia and the degree of aortic stenosis. In a second analysis, the variables that distinguish normotensive from hypertensive patients after stent implantation in the medium and long term were found. A binary logistic regression model has been fitted and it was concluded that the significant factors are aortic transverse arch hypoplasia, the systolic pressure gradient before stent implantation, the age at first stent implantation and the number of antihypertensive drugs the patient was taking before the intervention. In the third analysis, only patients who reduced their medication after stent implantation were selected and a Poisson regression model was fitted. We concluded that aortic transverse arch hypoplasia and the need for a second intervention of balloon dilatation or stent reimplantation are significant predictors of the number of antihypertensive drugs the patient needs in the medium and long term.
This study used an anonymised database of 79 patients with native or recurrent aortic coarctation who underwent stent implantation. This is a retrospective study, with clinical data collected on a routine basis. The main objective was to analyse the factors influencing the immediate, mid-term and long-term results of the intervention. A first analysis aimed to find the factors that influence the value of the systolic pressure gradient, immediately after stent implantation. Ordinal regression has been used and it was concluded that the significant factors are transverse arch hypoplasia and the degree of aortic stenosis. In a second analysis, the variables that distinguish normotensive from hypertensive patients after stent implantation in the medium and long term were found. A binary logistic regression model has been fitted and it was concluded that the significant factors are aortic transverse arch hypoplasia, the systolic pressure gradient before stent implantation, the age at first stent implantation and the number of antihypertensive drugs the patient was taking before the intervention. In the third analysis, only patients who reduced their medication after stent implantation were selected and a Poisson regression model was fitted. We concluded that aortic transverse arch hypoplasia and the need for a second intervention of balloon dilatation or stent reimplantation are significant predictors of the number of antihypertensive drugs the patient needs in the medium and long term.
Description
Keywords
Coartação da aorta Gradiente pressão sistólica Hipertensão Medicamentos Hipoplasia arco transverso Estenose da aorta Aortic coarctation Systolic pressure gradient Hypertension Hypertension Drug reduction Transverse arch hypoplasia Aortic stenosis