Reestenosis clínica en pacientes diabéticos con implante de stents liberadores de fármaco en lesiones de novo / Clinical restenosis in diabetic patients treated with drug eluting stents for de novo lesions

We evaluated immediate and mid-term clinical and angiographic results in diabetic patients with percutaneous coronary intervention with deployment of drug eluting stents. METHODS: Between November of 2004 and June of 2005 percutaneous coronary interventions were performed 860 with the deployment of 112 drug eluting stents to 42 diabetic patients. The mean of stents was 2.6 per patient, and the type of drug eluting stent was paclitaxel in 60% and sirolimus in 40%. The average of age was 51.2 +/- 9.6 years old. The gender was male in 25 (60%) of patients and female in 17 (40%). The indication of coronary angiography was unstable angina in 15 (35%) patients and stable angina in 27 (65%). There was history of anterior myocardial infarction in 20 (47%), inferior myocardial infarction in 8 (20%) and multiple vessel disease in 16 (38%). The stenosis severity of the lesion was 85.9% +/- 12.2% and the left ventricular function was (55 +/- 10). The hospital stay was 7 +/- 5.4 days. RESULTS: Both clinical and angiographic immediate success was 100%. The average follow was 7.6 +/- 3.3 months in 34 patients (80.9%). The target lesion revascularization (TLR) was 7.1%. (3 patients). Death, myocardial infarction or reinfarction (0%). COMPLICATIONS: One patient (2.3%) developed contrast induced nephropathy. CONCLUSIONS: These results suggest that the use of drug eluting stents (paclitaxel or sirolimus) in diabetic patients has a high rate of success with good angiographic and clinical results and with a low rate of complications or restenosis in this high risk group of patients.

Resultados a largo plazo de la valvuloplastía mitral percutánea con técnica de Inoue. Experiencia de 7 años del Hospital de Cardiología del CMN Siglo XXI. IMSS / Long-term results of mitral percutaneous valvuloplasty with Inoue technique. Seven-years experience at the Cardiology Hospital of the National Medical Center [quot ]Siglo XXI[quot ], IMSS

Since the last decade, percutaneous balloon mitral valvuloplasty with Inoue catheter is considered the treatment of choice for selected patients (mobile valve, no calcification and minimal subvalvular disease) with rheumatic mitral stenosis. OBJECTIVE: We present the seven-year follow-up experience of 456 patients treated with this technique in the catheter laboratory of the Cardiology Hospital in National Medical Center SXXI. MATERIAL AND METHODS: It is a retrospective, transversal and observational study performed with data obtained from January 1994 and December 2000, with a follow-up of 58.5 +/- 26.6 months (range 12-96 mean 22). RESULTS: We achieve an initial success of 82.8%, improvement of initial mitral valve area from 0.9 +/- 0.1 to 1.8 +/- 0.3 cm2, with a gain area from 88 to 106% (p < or = 0.001). At the end of the follow-up, the mean valvular area was maintained in 1.7 +/- 0.3 cm2 in 69.8% of the cases. We found a significant reduction of transmitral gradient and of the pulmonary artery systolic pressure immediately after the procedure; 93.1% of patients were in NYHA functional class II at the end of the follow-up, 11.6% presented complications (mitral regurgitation as the most important), in 15.9% of them, due to leaflet rupture, but only 9.1% corresponded to severe grade Ill-IV. COMPLICATIONS: Only one patient died due to septal perforation; 93.8% of the patients remained free of major cardiac events at the end of the study. Only 6.1% of the patients required surgery at the end of the follow-up; 5.5% were in functional class NYHA Ill-IV and restenosis occurred in 14.6%. CONCLUSION: Percutaneous balloon mitral valvuloplasty with Inoue balloon catheter is a safe and effective technique for treating rheumatic mitral stenosis with Wilkins score < 10, with minimal risk and complications and offers good life expectancy with absence of major cardiac events in > 90%. From these patients, 93.1% remained in NYHA-II or -I functional class and the incidence of restenosis decreased.

Resultados postimplante de stents coronarios en tronco coronario protegido y no protegido vs cirugía de revascularización / Results after placement of coronary stents in protected and not protected coronary trunk vs revascularization surgery

Evaluamos los resultados clínicos, angiográficos y el seguimiento en pacientes que fueron sometidos a angioplastía coronaria transluminal percutánea (ACTP) con colocación de "stents" en la enfermedad del tronco coronario izquierdo (TCI) y los comparamos con los enviados a cirugía de revascularización miocárdica (QX). Material y Métodos: De mayo de 1998 a octubre de 2003 se realizaron 3,680 procedimientos a 2,900 pacientes, se seleccionaron 30 pacientes, grupo GACTP; con colocación de stents en 17 protegidos y TCI no protegido, 13 inapropiados para cirugía por malos lechos y por rechazo del enfermo y grupo GRVM abordaje quirúrgico 30 pacientes, con promedio 3.2 puentes. Edades de 45 a 74 años (65.7 ± 11.5) para los de ACTP y para QX de 49 a 77 años (66.9 ± 7.1). Sexo masculino GACTP 25 (83%), GRVM 23 (76%), hipertensión arterial sistémica 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 según la Sociedad Canadiense de Cardiología (SCC) GACTP 17 (56%) GRVM 16 (53%) con enfermedad multivascular 20 (66%) ambos grupos. El porcentaje promedio de obstrucción 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 éxito 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 tardía libre de eventos adversos mayores (MUERTE o IAM) GACTP 25 (83.3%), un paciente con IAM y para GRVM 20 (66.6%) un paciente falleció en el seguimiento. Conclusiones: La colocación de stents en enfermedad de TCI es un procedimiento factible como una alternativa de revascularización miocárdica, con bajo porcentaje de complicaciones, en casos con función ventricular conservada a pesar de su mayor perfil de riesgo.

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.

Resultados a corto plazo de angioplastía de rescate en pacientes con infarto agudo de miocardio con trombólisis fallida / Short-term results of rescue angioplasty in patients with acute myocardial infarction and failure of thrombolysis treatment

El objetivo es describir nuestra experiencia, resultados clínicos y angiográficos inmediatos en pacientes con IAM sometidos a angioplastía coronaria transluminal percutánea de rescate (ACTPR). Material y métodos: Tipo de estudio; retrospectivo, observacional, transversal y descriptivo con seguimiento a 30 días. De enero de 2001 a julio de 2004 se realizaron 3,238 procedimientos de ACTP con aplicación de stent a pacientes con diagnóstico de cardiopatía isquémica por aterosclerosis coronaria, se seleccionó a 32 pacientes que representan el 0.98%, con edad de 47 a 79 años promedio de 63, 24 (75%) del sexo masculino, con hipertensión arterial sistémica 29 (90.6%), diabetes mellitus 18 (56.3%), hipercolesterolemia 11 (34.4%), tabaquismo 24 (75%), con antecedentes de angina inestable 9 (28.1%) y con infarto miocardio previo 2 (6.3%). La localización del IAM: anterior extenso 14 (43.8%), anteroseptal en 6 (18.8%), postero-inferior en 5 (15.6%), Pl con extensión eléctrica y/o hemodinámica en VD en 4 (12.5%), lateral en 1 (3.1%). Se trombolizaron en un tiempo promedio 3.19 horas (rango 2-7) con estreptoquinasa 19 (59.4%) y con rTPA 13 (40.6%), la CPK-MB pico (U) promedio de 348 ± 240. Con Killip Kimball (KK) 1 en cinco (15.6%), II 16 (50%), III 5 (15.6%) y IV 6 (18.8%) éstos manejados con balón intraaórtico de contrapulsación. Resultados: Llevados a sala de hemodinamia en un tiempo de 6 a 24 h encontrando flujo TIMI 0 en 16 (50%), TIMI 1 en diez (31.2%), TIMI 2 en seis (18.8%), promedio de vasos enfermos de 1.9. Se implantó stent en 27 (84.3%). Éxito angiográfico post ACTP más stent TIMI 3 en 24 (75%). Complicaciones: En 9(28.1%), en 7 (21.8%) con no reflujo y en 1 (3.1%) disección de la arteria coronaria relacionada con el IAM, 6 (18.7%) que fallecieron, en 4 (12.5%) con choque cardiogénico; 3 (9.3%) la ACTPR fue fallida. Conclusión: La ACTPR es un procedimiento de alto riesgo y pese a ello es una buena alternativa de tratamiento en pacientes con trombólisis fallida.

The present study is aimed at describing the short-term assessment of clinical and angiographic results in patients with acute myocardial infarction treated with rescue percutaneous transluminal coronary angioplasty (RPTCA). Methods: We reviewed retrospectively, from January 2001 to July 2004, the interventional procedures performed in patients with coronary heart disease. From a total of 3,258 patients we selected 32 (0.98%) with acute myocardial infarction and failure of thrombolysis treatment, which were treated with RPTCA to relief the symptoms. Average age was 63 years (range 47-79), there were 24 men (75%); hypertension in 29 (90.6%); diabetes mellitus in 18 (56.3%); currently smoking 24 (75%); dyslipidemia in 11 (34.4%); unstable angina in 9 (28.1%); previous myocardial infarction in 2 (6.3%). The area related to the infarction was anterior and lateral in 14 (43.8%), anteroseptal in 6 (18.8%), postero-inferior in 5 (15.6%) with electric and hemodynamic involvement in 4 (12.5%), lateral in 1(3.1 %). Thrombolysis treatment was delivered in 3.19 hours (range 2-7 hours) with streptokinasein 19 (59.4%) and rTPA in 13 (40.6%). The evaluated serum marker was CPK-MB with the highest level of 348 ± 240 U/L. Killip Kimball (KK) class was established as follows: KKI in 5 (15.6%), II in 16 (50%), III in 5 (15.6%), and IV in 6 (18.8%). Patients with cardiogenic shock were treated with intra-aortic balloon counterpulsation. Results: Time between symptoms and arrival to the cath lab was 11 hours (range 6-24 hours). TIMI flow was: TIMI 0 in 16(50%). TIMI 1 in 10 (31.2%), TIMI 2 in 6 (18.8%). The number of vessels with a significant lesion was 1.9 (range 1-4). Stents were placed in 27 (84.3%) patients. Angiographic success post-angioplasty was achieved in 24 (75%); there were 9 complications (28.1%), no reflow in 7 (21.8%), coronary dissection in 1 (3.1%). Six patients died (18.7%) and 4 of them (12.5%) were in cardiogenic shock. Conclusion: RPT-CA is a high-risk procedure, being an acceptable treatment option for patients with thrombolysis failure.

Isquemia miocárdica secundaria a fístula coronaria de la arteria descendente anterior con drenajes al tronco de la pulmonar / Myocardial ischemia secondary to anterior descending artery fistula

De la revisión de 4,400 pacientes consecutivos enviados a cateterismo cardiaco por sospecha de cardiopatía isquémica, se encontraron tres casos con esta patología, En este informe se presentan los datos clínicos y de gabinete, así como los angiográficos. Se revisó la literatura y el manejo actual. La fístula coronaria de la arteria descendente anterior con drenaje al tronco de la arteria pulmonar es una entidad extraordinariamente rara. Uno de esto enfermos además, presento lesión obstructiva fija e imagen de trombo en uno de los sistemas vasculares coronarios. El diagnóstico oportuno es relevante para un mejor pronóstico y tratamiento