Resultados postimplante de stents coronarios en tronco coronario protegido y no protegido vs cirugía de revascularización

Evaluamos los resultados clinicos, angiograficos y el seguimiento en pacientes que fueron sometidos a angioplastia coronaria transluminal percutanea (ACTP) con colocacion de "stents" en la enfermedad del tronco coronario izquierdo (TCI) y los comparamos con los enviados a cirugia de revascularizacion miocardica (QX). Material y Metodos: De mayo de 1998 a octubre de 2003 se realizaron 3,680 procedimientos a 2,900 pacientes, se seleccionaron 30 pacientes, grupo GACTP; con colocacion de stents en 17 protegidos y TCI no protegido, 13 inapropiados para cirugia por malos lechos y por rechazo del enfermo y grupo GRVM abordaje quirurgico 30 pacientes, con promedio 3.2 puentes. Edades de 45 a 74 anos (65.7 ± 11.5) para los de ACTP y para QX de 49 a 77 anos (66.9 ± 7.1). Sexo masculino GACTP 25 (83%), GRVM 23 (76%), hipertension arterial sistemica grupo 1 y 2: 10 (33%), tabaquismo grupo 1 y 2: 17 (56%), diabetes mellitus GACTP 11 (36%) GRVM tres (10%), hipercolesterolemia GACTP 19 (63%), GRVM 9 (30%), angina inestable segun la Sociedad Canadiense de Cardiologia (SCC) GACTP 17 (56%) GRVM 16 (53%) con enfermedad multivascular 20 (66%) ambos grupos. El porcentaje promedio de obstruccion fue de 90 ± 6.3%. La FE para el GACTP 30% a 55% 40.3 ± 8.7. GRVM 38% a 67% 48.6 ± 6.1. Resultados: El exito inmediato para el GACTP 26 (87%) y GRVM 28 (90%). Complicaciones: GACTP 4 (13%) GRVM 20 (66%). IAM perioperatorio GAC-TP 2 (6%) GRVM 8 (26%). La mortalidad del GACTP cuatro (13%) y GRVM 3 (10%). El seguimiento GACTP de 19.4 meses y GRVM 20 ± 3, fue obtenido en 26 del total del grupo. Sobrevida tardia libre de eventos adversos mayores (MUERTE o IAM) GACTP 25 (83.3%), un paciente con IAM y para GRVM 20 (66.6%) un paciente fallecio en el seguimiento. Conclusiones: La colocacion de stents en enfermedad de TCI es un procedimiento factible como una alternativa de revascularizacion miocardica, con bajo porcentaje de complicaciones, en casos con funcion ventricular conservada a pesar de su mayor perfil de riesgo.(AU) Introduction: We analyzed the clinical and angiographic results, as well as the follow-up of patients with left coronary trunk disease (LCT) subjected to percutaneous transluminal coronary angioplasty (PTCA) with stenting and compared them with those subjected to myocardial revascularization surgery (MRV). Material and methods: From May 1998 to October 2003, 3,680 procedures were performed in 2,900 patients; 30 of them were selected to form group PTCA, 17 protected with stenting and 13 not protected, as they were not suited for surgery due to inappropriate bedding and rejection by the patient. Another group of 30 patients (MRV) with coronary bypass, average of 3.2 grafts. Age ranged from 45 to 74 years (65.7 ± 11.5) for the PTCA and for MRV from 49 to 77 years (66.9 ± 7.1); 25 men (83%) in the PTCA group and 23 men (76%) in the MRV group. Systemic arterial hypertension in both groups: 10 (33%), smoking in both groups: 17 (56%); diabetes mellitus PTCA: 11 (36%) and MRV: 3 (10%); hypercholesterolemia PTCA: 19 (63%), MRV 9 (30%); unstable angina according to the Canadian Society of Cardiology (CSC) for PTCA: 17 (56%), MRV; 16 (53%); multivascular disease in both groups: 20 (66%). Average percentage of obstruction was of 90 ± 6.3%. FE for PTCA, 30 to 55% (40.3 ± 8.7) and for MRV, 38 to 67% (48.6 ±6.1). Results: Immediate success in 26 patients (87%) for the PTCA group and in 28 patients (90%) forthe MRV group. Complications: PTCA, 4 (13%) and MRV, 20 (66%). Perioperative IAM for PTCA, 2 (6%) and for MRV, 8 (26%). Mortality in the PTCA group was of 4 patients (13%) and in the MRV group of 3 (10%). Follow-up for PTCA, 19.4 months, for MRV of 20 ± 3, obtained in 26 of the whole group. Late survival adverse events (DEATH or IAM): PTCA, 25 (83.3%), one patient with IAM; MRV, 20 (66.6%), one patient died during the follow-up period. Conclusions: Placement of stents in the left coronary trunk disease is a feasible procedure as an alternative for myocardial revascularization, with a low rate of complications in cases of conserved ventricular function despite their higher risk profile.(AU)