Avaliação cardiológica pré operatória: custo efetividade do ecocardiograma com stress farmacológico comparado a angiografia coronariana em pacientes de alto risco cardiovascular assintomáticos, submetidos a transplante renal na Santa Casa de Juiz de Fora

Abstract

Kidney transplantation is the most cost-effective therapy in advanced chronic kidney disease, and coronary artery disease is the leading cause of death in the postoperative period. The cardiovascular risk assessment prior to the transplantation is important to stratify the possibility of major adverse events and to propose cardioprotective measures.Several flowcharts have been proposed for an objective assessment that allows for sensible and economic decisions. We performed an economic study with Decision Tree, follow-up of 6 months under SUS perspective evaluating cost effectiveness of dobutamine stress echocardiography (Group 2), compared to coronary angiography (Group 1), in the cardiac assessment of asymptomatic high cardiovascular risk renal transplant patients registered by Santa Casa de Misericórdia de Juiz de Fora. A total of 51 patients aged 18 years and over submitted to renal transplantation were selected from August 2012 to December 2017. Group 1: "Invasive Protocol" and Group 2: "Non-Invasive Protocol" were compared. Clinical outcomes were major cardiovascular events (cardiovascular death, acute myocardial infarction and stroke) and death from other causes. There were 8 major cardiovascular events (15%), with 6 events in Group 1 patients (20% vs. 9.5%, p = 0,311). Stratifying this outcome there were: cardiac death (13% vs. 0%, p = 0.08), nonfatal myocardial infarction (6.6% vs. 4.8%, p = 0.796) and stroke % vs. 4.8%, p = 0.227). Deaths from other causes were prevalent (33.3% vs. 38.1%, p = 0.726). In the economic analysis, the cost effectiveness plan demonstrated dominance relationship of the dobutamine stress echocardiogram on coronary angiography.We concluded that the dobutamine stress echocardiogram is cost effective in relation to coronary angiography, in the stratification of cardiovascular risk before kidney transplantation, in asymptomatic high-risk patients.