OBJECTIVE The aim of the present study was to investigate the factors associated with chronic post-sternotomy pain in heart surgery patients.METHODS Between January 2013 and February 2014, we evaluated 453 patients with >6 months post-sternotomy for cardiac surgery at a surgical outpatient clinic. The patients were allocated into a group with chronic post-sternotomy pain (n=178) and a control group without pain (n=275). The groups were compared for potential predictors of chronic post-sternotomy pain. We used Cox proportional hazards regression to determine which independent variables were associated with the development of chronic post-sternotomy pain.RESULTS In total, 39.29% of the patients had chronic poststernotomy pain. The following factors were significantly associated with chronic post-sternotomy pain: (a) use of the internal thoracic artery in coronary bypass grafting (P=0.009; HR=1.39; 95% CI, 1.08 to 1.80); (b) a history of antidepressant use (P=0.0001; HR=2.40; 95% CI, 1.74 to 3.32); (c) hypothyroidism (P=0.01; HR=1.27; 95% CI, 1.03 to 1.56); (d) surgical wound complication (P=0.01; HR=1.69; 95% CI, 1.08 to 2.63), and (e) patients on disability benefits or scheduled for a consultative medical examination for retirement (P=0.0002; HR=2.05; 95% CI, 1.40 to 3.02).CONCLUSION The factors associated with chronic poststernotomy pain were: use of the internal thoracic artery; use of antidepressants; hypothyroidism; surgical wound complication, and patients on disability benefits or scheduled for a consultative examination.

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INTRODUCTION:In patients with mechanical prosthetic heart valves or atrial fibrillation requiring anticoagulation to prevent thromboembolic events, several factors influence adherence and anticoagulation complications.OBJECTIVE:To evaluate the factors that interfere with the quality and complications of anticoagulation with vitamin K antagonists.METHODS:A retrospective cohort study of 100 patients, in the period from 2011 to 2014, was performed. Anticoagulation conditions in the last year, regarding the presence of complications (embolisms/bleeding) and inadequate treatment were assessed: achievement of less than 8 annual prothrombin times and International Normalized Ratio outside therapeutic target in more than 40% of prothrombin times.RESULTS:There were 31 complications (22 minor bleeding without hospitalization and 9 major complications: 7 bleeding with hospitalization and two emboli); 70 were with International Normalized Ratio outside the target in more than 40% of the tests and 36 with insufficient number of prothrombin times. Socioeconomic factors, anticoagulant type and anticoagulation reason had no relationship with complications or with inadequate treatment. There were more complications in patients with longer duration of anticoagulation (P=0.001). Women had more International Normalized Ratio outside the target range (OR 2.61, CI:1.0-6.5; P=0.04). Patients with lower number of annual prothrombin times had longer times of anticoagulation (P=0.03), less annual consultations (P=0.02) and less dose adjustments (P=0.003). Patients with longer duration of anticoagulation have more complications (P=0.001).CONCLUSION:There was a high rate of major complications and International Normalized Ratio was outside the goal. Less annual prothrombin times was related to longer duration of anticoagulation, less annual consultations and less dose adjustments. More major complications occurred in patients with longer duration of anticoagulation.

Introduction: A portion of patients affected by angina has ANOCA (angina with non-obstructive coronary arteries). Objectives: To determine the epidemiological and quality of life aspects of individuals with angina without coronary obstruction. Material and methods: This is an observational cross-sectional study, conducted by applying questionnaires (SAQ-7 and SF-36) in patients undergoing catheterization in a single hospital from September 2021 to June 2022, and who did not have significant coronary artery obstructions (≥50%). Results: Patients had a mean age of 59.2 years and 60.47% of the sample was female. The main comorbidities found were dyslipidemia (81.4%); hypertension (81.4%); and anxiety (55.81%). Regarding lifestyle habits, 67.44% of patients were sedentary and 34.88% were smokers. According to SAQ-7, for physical limitation, 34.88% patients were in the poor to fair grade. The quality of life had the worst results, with 86.05% of the sample presenting poor to fair. For SF-36, limitations for physical and emotional aspects had median of zero and functional capacity of 25. Discussion: ANOCA patients presented impacts mainly on quality of life, functional capacity, physical limitations, and limitations due to emotional problems, which is in agreement with literature data. Conclusion: Despite de absence of obstructive coronary lesions, patients with ANOCA have significant comorbidities and quality of life impairment, requiring atention from their physicians.

Objective: Verify whether lower preoperative serum albumin levels in cardiac surgery patients increase the incidence of acute kidney injury (AKI), pneumonia, postoperative stay in hospital and mortality. Methodology: A hundred and eighty-five medical records of patients that underwent cardiac surgery between January 2014 and December 2017 were surveyed. The albumin levels were compared between the group that presented at least one of the complications listed above and the group where that complication was not observed. The KDIGO criterion was used to define AKI. Pneumonia diagnosis was established based on clinical, radiologic and laboratory results. The postoperative time in hospital was considered increased when the patient had to stay for a period longer than 8 days. The mortality rate was defined by deaths that occurred up to 30 days after the surgery. Results: Albumin levels ≤3.87 mg/dL were associated to an increase in the risk to develop AKI (p= 0,0072). Albumin values ≤3.91 also increased the chance to have pneumonia (p= 0.0001). However, albumin was not statistically significant to predict mortality and increase in the postoperative stay in hospital. Conclusion: Serum albumin levels that were lower than or equal to 3.91 mg/dL and 3.87 mg/dL increased, respectively, the chances of developing both pneumonia and acute kidney injury after cardiac surgery. No significant results were obtained regarding albumin levels influence on postoperative stay in hospital or mortality.