Impacto del intervencionismo percutaneo en lesiones complejas en el INCOR - EsSalud (imleco)

Objetivos: Evaluar la asociacion entre la complejidad de las lesiones y los resultados angiogrsficos, eventos clinicos adversos al mes, a los 6 meses y al a±o. Metodos: Se revisaron retrospectivamente las historias clinicas de 154 pacientes que fueron sometidos a intervencionismo percutsneo coronario en el Instituto Nacional del Corazon- Hospital Guillermo Almenara Irigoyen, entre octubre del 2001 a setiembre del 2002. Se trataron 156 lesiones, de las cuales 91 eran lesiones complejas (definida como la lesion que muestra trombo, calcificacion, lesion ostial, bifurcacion, aneurisma, oclusion cronica o lesion en puente safeno) y 65 no complejas. Se analizaron variables clinicas, angiogrsficas y resultados de eventos adversos en el seguimiento. Resultados: La edad media de los pacientes fue de 61,7±10,2 a±os, el 83,8 por ciento correspondia al sexo masculino, 63,6 por ciento eran hipertensos y 18,8 por ciento diabeticos. El intervencionismo en lesiones complejas estuvo relacionado con mayor tasa de complicaciones periprocedimiento como fenomeno de no reflujo (71,4 por ciento, p OBJECTIVES: To evaluate association between coronary lesion complexity and angiographic results, clinical events at first, sixth and twelveth month. METHODS: We retrospectively reviewed clinical charts of 154 patients who underwent coronary percutaneous intervention at the Instituto Nacional del Corazon (INCOR) - National Hospital Guillermo Almenara Irigoyen, between October 2001 and September 2002. 156 lesiones were treated, 91 of them were complex ones (defined as a lesion with thrombus, calcified, ostial lesion, bifurcation, with aneurysm, closed cronically or lesion of a vein graft) and 65 non complex lesions. Clinical, angiographic and clinical events during the foolw up were analyzed. RESULTS: Mean age was 61.7±10.2 years old, 83.8 percent were male, 63.6 per cent had hypertension and 18.8 per cent were diabetic. Intervention in complex lesions was associated with higher rate of periprocedure complications as non reflow phenomenon(71.4 per cent pi0.000), side branch compromise (39.6 per cent pi0.000), dissection (8.8 per cent pi0.014), distal embolisation (7.7 per cent pi0.02) and adverse clinical events at one month of death (pi0.08), death/MI (pi0.05), CABG (pi0.014), death/MI/CABG (pi0.01), death/MI/CABG/hospitalization (pi0.004), at six months death (pi 0.02), death/MI (pi0.009), death/MI/CABG, death/MI,CABG/ hospitalization (pi0.000 ) and death at a year as CABG/death/ MI, death/I/CABG and death/MI,CABG/hospitalization (pi0.01). CONCLUSIONS: Patients with complex lesions showed higher rate of periprocedure complications and adverse cinical events (death, CABG, death/MI, death/MI/CABG and death/MI,CABG/hospitalization) at one, 6 and 12 months.