Octogenários: resultados de 3659 necropsias (12 anos de observação)

Iglézias, José Carlos R; Lourenção Jr, Artur; Dallan, Luís Alberto; Gutierres, Paulo Sampaio; Ramires, José Antônio F; Stolf, Noedir A. G; Oliveira, Sérgio Almeida de; Verginelli, Geraldo; Jatene, Adib D

doi:10.1590/S0102-76381993000100004

Resumos

No InCór, no período compreendido entre janeiro de 1978 e dezembro de 1990, foram realizadas 3659 necropsias, das quais 106 relativas a pacientes com idade > 80 anos. Destes, 55 (51,88%) eram do sexo masculino e 51 (48,11%) do feminino. A média de idade foi igual a 83,66 (80 a 93 anos). Dentre os principais sintomas (Gráfico 3) apresentados figuravam: a angima do peito em 40,56%, a dispnéia em 25,47% e a síncope em 8,49 deles. Em 47,16% dos pacientes os sintomas haviam se iniciado a mais de seis meses. Dentre os sistemas desencadeantes dos óbitos (Gráfico 1), encontramos o cardiovascular em 74,52%, o respiratório em 10,37%, o digestivo em 9,43%, o nervoso em 1,88%, o urinário em 1,88% e outros em 1,88%. Entre os óbitos cardiovasculares (Gráfico 2), 56,96% foram devidos a coronariopatia, 12,65% a miocardiopatia, 10,12% devido aos aneurismas da aorta e 8,86% atribuídos às arritmias. Baseados na casuística prévia e considerando: 1) que o sistema cardiovascular foi o maior determinante dos óbitos (74,52%); 2) que as coronariopatias foram responsáveis por 56,96% dos óbitos cardiovasculares; 3) que a revascularização convencional neste grupo tem mortalidade atual de 8,5%; 4) que a angioplastia primária foi bem sucedida em 93,2%, concluímos que ambas, a qualidade e a expectativa de vida, podem ser melhoradas trazendo o octogenário para próximo do médico, ou reduzindo o intervalo entre suas avaliações.

necropsias

Between January 1978 and December 1990, 3659 autopsies were performed in our Institution, of which 106 of the patients were > 80 years old. Of these patients, 55 (51.88%) were male and 51 (48.11%) female, and the mean age was 83.66 (80 to 93) years old. The main symptoms presented prior to death were: angina in 40.56%, dyspnea in 25.47%%, and syncope in 8.49% of the patients. In 47.16% the symptoms had begun more than six months before. The systems related to the cause of death were found to be: cardiovascular in 74.52%, respiratory in 10.37%, digestive in 9.43%, nervous in 1.88%, urinary in 1.88% and others in 1.88%. Among the cardiovascular deaths: 56.96% were due to coronary artery disease, 12.65% due to myocardiopathy, 10.12% due to thoracic aortic aneurysm and 8.86% were atributed to arrythmias. It was considered that: the cardiovascular system was the major determinant of death in 74.52%, coronary disease was responsible for 56.96% of the cardiovascular deaths, standard revascularization in this group has a mortality rate of 8.5% and that primary angioplasty has had a success rate of 93.2%. It was therefore concluded that the patients of at least 80 years old should be maintained near their physician or the time between their medical check-up be reduced in order to significantly improve their quality and expectancy of life.

necropsies

ARTIGOS ORIGINAIS

Octogenários: resultados de 3659 necropsias (12 anos de observação)

Octagenarians: results of 3659 necropsies

José Carlos R. Iglézias^I; Artur Lourenção Jr.; Luís Alberto Dallan^I; Paulo Sampaio Gutierres^I; José Antônio F. Ramires^I; Noedir A. G. Stolf^I; Sérgio Almeida de Oliveira^I; Geraldo Verginelli^I; Adib D. Jatene^I

^IDo Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

^{Endereço para separatas} Endereço para separatas: José Carlos Iglesias Divisão Cirúrgica Av. Dr. Enéas de Carvalho Aguiar, 44 05403 São Paulo, SP, Brasil

RESUMO

No InCór, no período compreendido entre janeiro de 1978 e dezembro de 1990, foram realizadas 3659 necropsias, das quais 106 relativas a pacientes com idade > 80 anos. Destes, 55 (51,88%) eram do sexo masculino e 51 (48,11%) do feminino. A média de idade foi igual a 83,66 (80 a 93 anos). Dentre os principais sintomas (Gráfico 3) apresentados figuravam: a angima do peito em 40,56%, a dispnéia em 25,47% e a síncope em 8,49 deles. Em 47,16% dos pacientes os sintomas haviam se iniciado a mais de seis meses. Dentre os sistemas desencadeantes dos óbitos (Gráfico 1), encontramos o cardiovascular em 74,52%, o respiratório em 10,37%, o digestivo em 9,43%, o nervoso em 1,88%, o urinário em 1,88% e outros em 1,88%. Entre os óbitos cardiovasculares (Gráfico 2), 56,96% foram devidos a coronariopatia, 12,65% a miocardiopatia, 10,12% devido aos aneurismas da aorta e 8,86% atribuídos às arritmias. Baseados na casuística prévia e considerando: 1) que o sistema cardiovascular foi o maior determinante dos óbitos (74,52%); 2) que as coronariopatias foram responsáveis por 56,96% dos óbitos cardiovasculares; 3) que a revascularização convencional neste grupo tem mortalidade atual de 8,5%; 4) que a angioplastia primária foi bem sucedida em 93,2%, concluímos que ambas, a qualidade e a expectativa de vida, podem ser melhoradas trazendo o octogenário para próximo do médico, ou reduzindo o intervalo entre suas avaliações.

Descritores: necropsias, pacientes idosos.

ABSTRACT

Between January 1978 and December 1990, 3659 autopsies were performed in our Institution, of which 106 of the patients were > 80 years old. Of these patients, 55 (51.88%) were male and 51 (48.11%) female, and the mean age was 83.66 (80 to 93) years old. The main symptoms presented prior to death were: angina in 40.56%, dyspnea in 25.47%%, and syncope in 8.49% of the patients. In 47.16% the symptoms had begun more than six months before. The systems related to the cause of death were found to be: cardiovascular in 74.52%, respiratory in 10.37%, digestive in 9.43%, nervous in 1.88%, urinary in 1.88% and others in 1.88%. Among the cardiovascular deaths: 56.96% were due to coronary artery disease, 12.65% due to myocardiopathy, 10.12% due to thoracic aortic aneurysm and 8.86% were atributed to arrythmias. It was considered that: the cardiovascular system was the major determinant of death in 74.52%, coronary disease was responsible for 56.96% of the cardiovascular deaths, standard revascularization in this group has a mortality rate of 8.5% and that primary angioplasty has had a success rate of 93.2%. It was therefore concluded that the patients of at least 80 years old should be maintained near their physician or the time between their medical check-up be reduced in order to significantly improve their quality and expectancy of life.

Descriptors: necropsies, elderly patients.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido para publicação em 28 de março de 1993.

Trabalho realizado no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brasil.

1 ARONOW, W. S.; AHN, C.; KRONZON, I. - Prognosis of congestive heart failure in elderly patients with normal versus abnormal left ventricular systolic function associated with coronary artery disease. Am. J. Cardiol, 66: 1257-1259, 1990.
2 CHAITMAN, B. R.; RYAN, T. J.; KRONWAL, R. A.; FORSTER, E. D.; FROMMER, P. L.; KILLIP, T. - Coronary artery surgery study (CASS). Comparability of 10 year survival in randomized and randomizable patients. J. Am. Coll. Cardiol, 16: 1071-1078, 1990.
3 COHN, J. N. & JOHNSON, G. and Veterans Administration Cooperative Study Group. - Heart failure with normal ejection fraction: the V-Heft study. Circulation, 8 (Suppl. 3):48-53, 1990.
4 IGLÉZIAS, J. C. R.; DALLAN, L. A. O.; OLIVEIRA, S. F.; RAMIRES, J. A. F.; OLIVEIRA, S. A.; VERGINELLI, G.; PILEGGI, F.; JATENE, A. D. - Revascularizacáo do miocardio no paciente octogenário. Rev. Bras. Cir. Cardiovsc, 5: 183-186, 1990.
5 KOWALCHUK, G. J.; SIU, S. C.; LEWIS, S. M. - Coronary artery disease in the octogenarian: angiographic spectrum and suitability for revascularization. Am. J. Crdiol, 66: 1319-1323, 1990.
6 LOOP, F. D.; LYTLE, B. W.; COSGROVE, D. M.; GOORMASTIC, M.; TAYLOR, P. C.; GOLDING, L. A. R.; STEWART, R. W.; GILL, C. C. - Coronary artery bypass graft surgery in the elderly. Cleveland Clin. J. Med, 55: 23-34, 1988.
7 MACAYA, C.; ALFONSO, F.; INIGUEZ, A.; ZARCO, P. - Long term clinical and angiographic follow-up of percutaneous transluminal coronary angioplasty in patients greater than or equal to 65 yers of age. Am. J. Cardiol, 66: 1513-1515, 1990.
8 MULLANY, C.J.; DARLING, G. E.; PLUTH, J. R.; ORSZULAK, T. A.; SCHAFF, H. V.; ILSTRUP, D. M.; GERSH, B. J. - Early and late results after isolated coronary artery bypass surgery in 159 patients aged 80 years and older. Circulation, 82 (Supl. 4):229-236, 1990.
9 RENKIN, J.; MELIN, J.; ROBERT, A.; RICHELLE, F.; BACHY, J. L.; COP, J.; DETRY, J. M.; WIJNS, W. - Detection of restenosis after successful coronary angioplasty: improved clinical decision making with use of logistic model combining procedural and follow-up variables. J. Am. Coll. Cardiol, 16: 1333-1340, 1990.
10 ROBERTS, W. C.; KRAGEL, A. H.; POTKIN, B. N. - Ages at death and sex distribution in age decade in fatal coronary artery disease. Am. J. Cardiol, 66: 1379-1381, 1990.
11 WEINTRAUB, W. S.; COHEN, C. L.; CURLING, P. E.; JONES, E. L; CRAVER, J. M.; GUYTON, R.; KING III, S. B.; DOUGLAS, J. S. - Results of coronary surgery after failed elective coronary angioplasty in patients with prior coronary surgery. J. Am. Coll. Cardiol, 16: 1341-1347, 1990.

Endereço para separatas:

José Carlos Iglesias

Divisão Cirúrgica

Av. Dr. Enéas de Carvalho Aguiar, 44

05403 São Paulo, SP, Brasil

Datas de Publicação

Publicação nesta coleção
17 Fev 2011
Data do Fascículo
Mar 1993

Histórico

Recebido
28 Mar 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1 ARONOW, W. S.; AHN, C.; KRONZON, I. - Prognosis of congestive heart failure in elderly patients with normal versus abnormal left ventricular systolic function associated with coronary artery disease. Am. J. Cardiol, 66: 1257-1259, 1990.

[2] 2 CHAITMAN, B. R.; RYAN, T. J.; KRONWAL, R. A.; FORSTER, E. D.; FROMMER, P. L.; KILLIP, T. - Coronary artery surgery study (CASS). Comparability of 10 year survival in randomized and randomizable patients. J. Am. Coll. Cardiol, 16: 1071-1078, 1990.

[3] 3 COHN, J. N. & JOHNSON, G. and Veterans Administration Cooperative Study Group. - Heart failure with normal ejection fraction: the V-Heft study. Circulation, 8 (Suppl. 3):48-53, 1990.

[4] 4 IGLÉZIAS, J. C. R.; DALLAN, L. A. O.; OLIVEIRA, S. F.; RAMIRES, J. A. F.; OLIVEIRA, S. A.; VERGINELLI, G.; PILEGGI, F.; JATENE, A. D. - Revascularizacáo do miocardio no paciente octogenário. Rev. Bras. Cir. Cardiovsc, 5: 183-186, 1990.

[5] 5 KOWALCHUK, G. J.; SIU, S. C.; LEWIS, S. M. - Coronary artery disease in the octogenarian: angiographic spectrum and suitability for revascularization. Am. J. Crdiol, 66: 1319-1323, 1990.

[6] 6 LOOP, F. D.; LYTLE, B. W.; COSGROVE, D. M.; GOORMASTIC, M.; TAYLOR, P. C.; GOLDING, L. A. R.; STEWART, R. W.; GILL, C. C. - Coronary artery bypass graft surgery in the elderly. Cleveland Clin. J. Med, 55: 23-34, 1988.

[7] 7 MACAYA, C.; ALFONSO, F.; INIGUEZ, A.; ZARCO, P. - Long term clinical and angiographic follow-up of percutaneous transluminal coronary angioplasty in patients greater than or equal to 65 yers of age. Am. J. Cardiol, 66: 1513-1515, 1990.

[8] 8 MULLANY, C.J.; DARLING, G. E.; PLUTH, J. R.; ORSZULAK, T. A.; SCHAFF, H. V.; ILSTRUP, D. M.; GERSH, B. J. - Early and late results after isolated coronary artery bypass surgery in 159 patients aged 80 years and older. Circulation, 82 (Supl. 4):229-236, 1990.

[9] 9 RENKIN, J.; MELIN, J.; ROBERT, A.; RICHELLE, F.; BACHY, J. L.; COP, J.; DETRY, J. M.; WIJNS, W. - Detection of restenosis after successful coronary angioplasty: improved clinical decision making with use of logistic model combining procedural and follow-up variables. J. Am. Coll. Cardiol, 16: 1333-1340, 1990.

[10] 10 ROBERTS, W. C.; KRAGEL, A. H.; POTKIN, B. N. - Ages at death and sex distribution in age decade in fatal coronary artery disease. Am. J. Cardiol, 66: 1379-1381, 1990.

[11] 11 WEINTRAUB, W. S.; COHEN, C. L.; CURLING, P. E.; JONES, E. L; CRAVER, J. M.; GUYTON, R.; KING III, S. B.; DOUGLAS, J. S. - Results of coronary surgery after failed elective coronary angioplasty in patients with prior coronary surgery. J. Am. Coll. Cardiol, 16: 1341-1347, 1990.