{"id":685,"date":"2026-03-16T15:35:11","date_gmt":"2026-03-16T15:35:11","guid":{"rendered":"https:\/\/msnacif.med.br\/home\/?p=685"},"modified":"2026-03-20T13:28:06","modified_gmt":"2026-03-20T13:28:06","slug":"medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose","status":"publish","type":"post","link":"https:\/\/msnacif.med.br\/home\/medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose\/","title":{"rendered":"Medicina baseada Em valor"},"content":{"rendered":"<p><!-- ===================================================== COLE TODO ESTE BLOCO em um bloco \"HTML Personalizado\" no editor do WordPress (Gutenberg ou Cl\u00e1ssico). ===================================================== --><\/p>\n<style>\n<p>\/* \u2500\u2500 Vari\u00e1veis \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 *\/<\/p>\n<p>.wp-ccta-article {<br \/>  --primary: #0f4c81;<br \/>  --primary-dark: #0a365c;<br \/>  --accent: #eaf3fb;<br \/>  --border: #dbe3ea;<br \/>  --text: #1f2937;<br \/>  --muted: #6b7280;<br \/>  --bg: #ffffff;<br \/>}<\/p>\n<p>\/* \u2500\u2500 Container \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 *\/<\/p>\n<p>.wp-ccta-article{<br \/>font-family:-apple-system,BlinkMacSystemFont,\"Segoe UI\",Roboto,Arial,sans-serif;<br \/>color:var(--text);<br \/>line-height:1.65;<br \/>background:var(--bg);<br \/>border:1px solid var(--border);<br \/>border-radius:16px;<br \/>padding:32px;<br \/>box-shadow:0 8px 24px rgba(15,76,129,.08);<br \/>}<\/p>\n<p>\/* \u2500\u2500 T\u00edtulos \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 *\/<\/p>\n<p>.wp-ccta-article h1{<br \/>font-size:2rem;<br \/>margin-bottom:6px;<br \/>color:var(--primary-dark);<br \/>}<\/p>\n<p>.wp-ccta-article h2{<br \/>margin-top:30px;<br \/>border-left:4px solid var(--primary);<br \/>padding-left:10px;<br \/>font-size:1.3rem;<br \/>color:var(--primary-dark);<br \/>}<\/p>\n<p>.wp-ccta-article h3{<br \/>margin-top:20px;<br \/>font-size:1.1rem;<br \/>color:var(--primary-dark);<br \/>}<\/p>\n<p>\/* \u2500\u2500 Texto \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 *\/<\/p>\n<p>.wp-ccta-article p{<br \/>margin-bottom:14px;<br \/>}<\/p>\n<p>.wp-ccta-article .lead{<br \/>font-size:1.05rem;<br \/>}<\/p>\n<p>\/* \u2500\u2500 Caixa de destaque \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 *\/<\/p>\n<p>.note-box{<br \/>background:#f8fbff;<br \/>border-left:5px solid var(--primary);<br \/>padding:14px 16px;<br \/>border-radius:10px;<br \/>margin:20px 0;<br \/>}<\/p>\n<p>\/* \u2500\u2500 Cards \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 *\/<\/p>\n<p>.grid{<br \/>display:grid;<br \/>gap:14px;<br \/>grid-template-columns:1fr;<br \/>margin:20px 0;<br \/>}<\/p>\n<p>@media(min-width:800px){<br \/>.grid{<br \/>grid-template-columns:repeat(3,1fr);<br \/>}<br \/>}<\/p>\n<p>.card{<br \/>border:1px solid var(--border);<br \/>border-radius:12px;<br \/>padding:14px;<br \/>background:white;<br \/>}<\/p>\n<p>.card.cac{<br \/>border-left:4px solid #0f766e;<br \/>}<\/p>\n<p>.card.ccta{<br \/>border-left:4px solid #0f4c81;<br \/>}<\/p>\n<p>.card.ldl{<br \/>border-left:4px solid #92400e;<br \/>}<\/p>\n<p>\/* \u2500\u2500 Rodap\u00e9 \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 *\/<\/p>\n<p>.footer{<br \/>margin-top:25px;<br \/>border-top:1px dashed var(--border);<br \/>padding-top:14px;<br \/>font-size:0.95rem;<br \/>color:var(--muted);<br \/>}<\/p>\n<\/style>\n<h3 class=\"wp-ccta-article\">AngioTC de coron\u00e1ria: uma forma de personalizar e acompanhar o tratamento da aterosclerose<\/h3>\n<p class=\"wp-ccta-article\">Como m\u00e9dico que realiza angioTC de coron\u00e1ria h\u00e1 mais de duas d\u00e9cadas, entendo que o maior valor do m\u00e9todo n\u00e3o est\u00e1 apenas em identificar estenose significativa. O verdadeiro ganho cl\u00ednico da angiotomografia coron\u00e1ria \u00e9 permitir que o m\u00e9dico deixe de trabalhar exclusivamente com probabilidade estat\u00edstica e passe a visualizar a doen\u00e7a ateroscler\u00f3tica de forma concreta, individualizada e biologicamente coerente.<\/p>\n<div><\/div>\n<div class=\"wp-ccta-article\">\n<div class=\"note-box\"><strong>Ponto central:<\/strong> a imagem coron\u00e1ria transforma risco estimado em doen\u00e7a documentada, aproximando a preven\u00e7\u00e3o cardiovascular da medicina individualizada.<\/div>\n<h3>Diretriz de dislipidemia 2026: mudan\u00e7a de paradigma<\/h3>\n<p>A diretriz americana de dislipidemia de 2026 consolidou uma mudan\u00e7a importante no racioc\u00ednio cl\u00ednico. O documento reafirma metas de LDL-C, destaca o impacto da exposi\u00e7\u00e3o cumulativa \u00e0s lipoprote\u00ednas aterog\u00eanicas ao longo da vida e amplia o papel do escore de c\u00e1lcio coron\u00e1rio (CAC) na estratifica\u00e7\u00e3o de risco e na personaliza\u00e7\u00e3o da intensidade terap\u00eautica.<\/p>\n<p>Para cl\u00ednicos e cardiologistas, a mensagem \u00e9 clara: colesterol continua central, mas a imagem passou a ter papel decisivo no refinamento da conduta.<\/p>\n<h3>O escore de c\u00e1lcio na pr\u00e1tica cl\u00ednica<\/h3>\n<p>O escore de c\u00e1lcio coron\u00e1rio n\u00e3o deve ser interpretado de forma simplista. Um CAC zero pode reduzir incertezas em determinados cen\u00e1rios de preven\u00e7\u00e3o prim\u00e1ria, especialmente quando ainda existe d\u00favida sobre iniciar terapia farmacol\u00f3gica.<\/p>\n<p>Entretanto, CAC zero n\u00e3o significa aus\u00eancia absoluta de risco e n\u00e3o deve ser utilizado para \u201cdesriscar\u201d pacientes com hipercolesterolemia familiar, tabagismo ativo, diabetes em certos contextos ou hist\u00f3ria familiar muito forte de doen\u00e7a coronariana.<\/p>\n<div class=\"grid\">\n<div class=\"card cac\">\n<h4>Escore de c\u00e1lcio (CAC)<\/h4>\n<ul>\n<li>Ferramenta robusta de reclassifica\u00e7\u00e3o de risco<\/li>\n<li>Particularmente \u00fatil em preven\u00e7\u00e3o prim\u00e1ria<\/li>\n<li>CAC zero reduz incerteza cl\u00ednica<\/li>\n<li>CAC elevado favorece intensifica\u00e7\u00e3o terap\u00eautica<\/li>\n<\/ul>\n<\/div>\n<div class=\"card ccta\">\n<h4>AngioTC de coron\u00e1ria<\/h4>\n<ul>\n<li>Detecta aterosclerose mesmo sem calcifica\u00e7\u00e3o<\/li>\n<li>Avalia extens\u00e3o da doen\u00e7a<\/li>\n<li>Diferencia placas calcificadas e n\u00e3o calcificadas<\/li>\n<li>Identifica sinais de vulnerabilidade da placa<\/li>\n<\/ul>\n<\/div>\n<div class=\"card ldl\">\n<h4>LDL e aterosclerose<\/h4>\n<ul>\n<li>LDL \u00e9 agente causal da aterosclerose<\/li>\n<li>Exposi\u00e7\u00e3o cumulativa ao longo da vida importa<\/li>\n<li>Particularmente relevante em jovens e diab\u00e9ticos<\/li>\n<li>Imagem complementa, mas n\u00e3o substitui a fisiopatologia<\/li>\n<\/ul>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone size-full wp-image-691\" src=\"https:\/\/msnacif.med.br\/home\/wp-content\/uploads\/2026\/03\/WhatsApp-Image-2026-03-16-at-12.32.38.jpeg\" alt=\"\" width=\"1024\" height=\"1024\" srcset=\"https:\/\/msnacif.med.br\/home\/wp-content\/uploads\/2026\/03\/WhatsApp-Image-2026-03-16-at-12.32.38.jpeg 1024w, https:\/\/msnacif.med.br\/home\/wp-content\/uploads\/2026\/03\/WhatsApp-Image-2026-03-16-at-12.32.38-300x300.jpeg 300w, https:\/\/msnacif.med.br\/home\/wp-content\/uploads\/2026\/03\/WhatsApp-Image-2026-03-16-at-12.32.38-150x150.jpeg 150w, https:\/\/msnacif.med.br\/home\/wp-content\/uploads\/2026\/03\/WhatsApp-Image-2026-03-16-at-12.32.38-768x768.jpeg 768w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<\/div>\n<\/div>\n<h3>O valor da angiotomografia coron\u00e1ria<\/h3>\n<p>A angioTC permite ir al\u00e9m da simples pergunta sobre presen\u00e7a de obstru\u00e7\u00e3o. O m\u00e9todo identifica presen\u00e7a de placa ateroscler\u00f3tica, avalia extens\u00e3o da doen\u00e7a e caracteriza padr\u00f5es de placa.<\/p>\n<p>Mesmo pacientes com CAC zero podem apresentar aterosclerose n\u00e3o calcificada detect\u00e1vel na angioTC. A tomografia tamb\u00e9m permite identificar sinais associados a maior risco, como placa de baixa atenua\u00e7\u00e3o, remodelamento positivo e calcifica\u00e7\u00f5es puntiformes.<\/p>\n<h3>Evid\u00eancia cl\u00ednica: estudo SCOT-HEART<\/h3>\n<p>Os resultados de 10 anos do estudo SCOT-HEART mostraram que a estrat\u00e9gia guiada por angiotomografia coron\u00e1ria em pacientes com dor tor\u00e1cica est\u00e1vel reduziu morte por doen\u00e7a coronariana ou infarto n\u00e3o fatal, especialmente infarto n\u00e3o fatal.<\/p>\n<p>Esse benef\u00edcio ocorreu principalmente pela intensifica\u00e7\u00e3o sustentada de terapias preventivas ap\u00f3s documenta\u00e7\u00e3o anat\u00f4mica da aterosclerose.<\/p>\n<div class=\"note-box\">Visualizar a aterosclerose mudou o comportamento terap\u00eautico \u2014 aumentando o uso de estatinas e outras estrat\u00e9gias preventivas e reduzindo eventos cardiovasculares ao longo do tempo.<\/div>\n<h3>Fenotipagem da aterosclerose<\/h3>\n<p>A tomografia coron\u00e1ria n\u00e3o mede apenas estreitamento luminal. Estudos derivados do SCOT-HEART demonstraram que a carga de placa n\u00e3o calcificada de baixa atenua\u00e7\u00e3o foi um dos preditores mais fortes de infarto, superando a avalia\u00e7\u00e3o baseada apenas na estenose.<\/p>\n<p>Isso refor\u00e7a um conceito fundamental: a angioTC permite caracterizar biologicamente a aterosclerose.<\/p>\n<h3>Aplica\u00e7\u00f5es cl\u00ednicas mais amplas<\/h3>\n<p>Al\u00e9m da preven\u00e7\u00e3o, a angiotomografia tamb\u00e9m pode contribuir em cen\u00e1rios agudos e no planejamento terap\u00eautico. Dados derivados do estudo VERDICT mostraram associa\u00e7\u00e3o entre extens\u00e3o da doen\u00e7a na angioTC e progn\u00f3stico em s\u00edndromes coronarianas agudas sem supra de ST.<\/p>\n<p>Da mesma forma, experi\u00eancias discutidas a partir do estudo SYNTAX II sugerem que a angioTC pode participar do planejamento terap\u00eautico integrando anatomia coron\u00e1ria, carga ateroscler\u00f3tica e avalia\u00e7\u00e3o funcional, inclusive com FFR-CT.<\/p>\n<h3>Conclus\u00e3o pr\u00e1tica<\/h3>\n<p>O escore de c\u00e1lcio continua sendo excelente ferramenta de reclassifica\u00e7\u00e3o de risco em preven\u00e7\u00e3o prim\u00e1ria. J\u00e1 a angiotomografia coron\u00e1ria \u00e9 particularmente valiosa quando a pergunta cl\u00ednica envolve presen\u00e7a real de aterosclerose, caracteriza\u00e7\u00e3o da placa ou necessidade de individualizar intensidade terap\u00eautica.<\/p>\n<p>Depois de mais de duas d\u00e9cadas acompanhando a evolu\u00e7\u00e3o do m\u00e9todo, a angioTC de coron\u00e1ria se consolidou como uma das ferramentas mais inteligentes para aproximar preven\u00e7\u00e3o cardiovascular de medicina personalizada.<\/p>\n<div class=\"footer\">\n<p><strong>Refer\u00eancias selecionadas<\/strong><\/p>\n<p>Lima MR, Lopes PM, Ferreira AM. Use of coronary artery calcium score and coronary CT angiography to guide cardiovascular prevention and treatment. Ther Adv Cardiovasc Dis. 2024;18:17539447241249650.<\/p>\n<p>Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC\/AHA\/AACVPR\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA guideline on the management of dyslipidemia: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. Published online March 13, 2026. doi:10.1016\/j.jacc.2025.11.016.<\/p>\n<p>Boren J, Chapman MJ, Krauss RM, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2020;41:2313-30.<\/p>\n<p>Williams MC, Wereski R, Tuck C, et al. Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland. Lancet. 2025;405:329-37.<\/p>\n<p>Williams MC, Kwiecinski J, Doris M, et al. Low-attenuation noncalcified plaque on coronary computed tomography angiography predicts myocardial infarction: results from the multicenter SCOT-HEART trial. Circulation. 2020;141:1452-62.<\/p>\n<p>Kuhl JT, Kelbaek H, Linde JJ, et al. Coronary CT angiography as a guide to timing of invasive treatment in patients with NSTEACS. JACC Cardiovasc Imaging. 2023;16:1353-5.<\/p>\n<p>Norgaard BL, Leipsic J, Achenbach S. Coronary CT angiography to guide treatment decision making: lessons from the SYNTAX II trial. J Am Coll Cardiol. 2018;71:2770-2.<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>AngioTC de coron\u00e1ria: uma forma de personalizar e acompanhar o tratamento da aterosclerose<br \/>\nComo m\u00e9dico que realiza angioTC de coron\u00e1ria h\u00e1 mais de duas d\u00e9cadas, entendo que o maior valor do m\u00e9todo n\u00e3o est\u00e1 apenas em identificar estenose significativa. O verdadeiro ganho cl\u00ednico da angiotomografia coron\u00e1ria \u00e9 permitir que o m\u00e9dico deixe de trabalhar exclusivamente com probabilidade estat\u00edstica e passe a visualizar a doen\u00e7a ateroscler\u00f3tica de forma concreta, individualizada e biologicamente coerente.<\/p>\n","protected":false},"author":2,"featured_media":692,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_joinchat":[],"footnotes":""},"categories":[11],"tags":[],"class_list":["post-685","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Medicina baseada Em valor - Dr. Marcelo Nacif<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/msnacif.med.br\/home\/medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Medicina baseada Em valor - Dr. Marcelo Nacif\" \/>\n<meta property=\"og:description\" content=\"AngioTC de coron\u00e1ria: uma forma de personalizar e acompanhar o tratamento da aterosclerose Como m\u00e9dico que realiza angioTC de coron\u00e1ria h\u00e1 mais de duas d\u00e9cadas, entendo que o maior valor do m\u00e9todo n\u00e3o est\u00e1 apenas em identificar estenose significativa. O verdadeiro ganho cl\u00ednico da angiotomografia coron\u00e1ria \u00e9 permitir que o m\u00e9dico deixe de trabalhar exclusivamente com probabilidade estat\u00edstica e passe a visualizar a doen\u00e7a ateroscler\u00f3tica de forma concreta, individualizada e biologicamente coerente.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/msnacif.med.br\/home\/medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose\/\" \/>\n<meta property=\"og:site_name\" content=\"Dr. Marcelo Nacif\" \/>\n<meta property=\"article:published_time\" content=\"2026-03-16T15:35:11+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-03-20T13:28:06+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/msnacif.med.br\/home\/wp-content\/uploads\/2026\/03\/WhatsApp-Image-2026-03-16-at-12.26.40.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"1536\" \/>\n\t<meta property=\"og:image:height\" content=\"1024\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Conectou!\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Conectou!\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/msnacif.med.br\/home\/medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/msnacif.med.br\/home\/medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose\/\"},\"author\":{\"name\":\"Conectou!\",\"@id\":\"https:\/\/msnacif.med.br\/home\/#\/schema\/person\/a0519eecab3cb36429bece6470836d1b\"},\"headline\":\"Medicina baseada Em valor\",\"datePublished\":\"2026-03-16T15:35:11+00:00\",\"dateModified\":\"2026-03-20T13:28:06+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/msnacif.med.br\/home\/medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose\/\"},\"wordCount\":1016,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/msnacif.med.br\/home\/#organization\"},\"image\":{\"@id\":\"https:\/\/msnacif.med.br\/home\/medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/msnacif.med.br\/home\/wp-content\/uploads\/2026\/03\/WhatsApp-Image-2026-03-16-at-12.26.40.jpeg\",\"articleSection\":[\"Blog\"],\"inLanguage\":\"pt-BR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/msnacif.med.br\/home\/medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/msnacif.med.br\/home\/medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose\/\",\"url\":\"https:\/\/msnacif.med.br\/home\/medicina-baseada-em-valor-angiotc-de-coronaria-uma-forma-de-personalizar-e-acompanhar-o-tratamento-da-aterosclerose\/\",\"name\":\"Medicina baseada Em valor - 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