ABSTRACT
El rol del género tras la implantación de stents coronarios aún suscita controversias. Se diseñó un estudio para caracterizar la evolución, a mediano plazo, de mujeres tratadas con stents coronarios entre enero del 2006 y diciembre del 2007. Se consideraron eventos cardíacos adversos mayores (ECAM): muerte cardíaca, infarto del miocardio no fatal y necesidad de revascularización de la lesión diana. Las tasas de supervivencia fueron estimadas por el método de Kaplan Meier. Se empleó el modelo de regresión de Cox en el análisis multivariado. Se incluyeron 162 mujeres, durante el seguimiento (12,9±4,7 meses), 32 sufrieron algún evento mayor, 3 presentaron infarto del miocardio no fatal y sólo una falleció. Las tasas de supervivencia libres de ECAM y revascularización de la lesión diana al año resultaron de 69,49 y 78,07 %, respectivamente. La intervención multiarterial, la implantación de stents con diámetro menor de 3 mm y la disfunción sistólica del ventrículo izquierdo ensombrecieron el pronóstico durante el seguimiento.
Gender role after coronary stents implantation even arouse controversies. This is a study to characterize the medium term course of women treated with coronary stents from January 2006 to December 2007. The following adverse cardiac major events (ACME) were considered: cardiac death, non-fatal myocardium infarct, and the need of revascularization of target lesion. Survival rates were estimated by means of Kaplan Meier method. In multivariate analysis Cox regression model was used. Were included 162 women during follow-up (12,9±4,7 months), 32 had some mayor event, 3 had a non-fatal myocardium infarct with only one deceased . ACME-free survival and revascularization of target lesions at a year were of 69,49 and 78,07 %, respectively. Multi-arteries intervention, stents implantation with a diameter lesser than 3 mm, and systolic dysfunction of left ventricle shadowed the prognosis during follow-up.
ABSTRACT
Discutimos os resultados dos sete estudos randomizados comparando a angioplastia transluminal coronária e a cirurgia de revascularização miocárdica no tratamento da doença coronária obstrutiva em pacientes multiarteriais. Os resultados demonstram que a mortalidade tardia foi semelhante entre as duas opções de tratamento e que a necessidade de reintervenção foi maior nos pacientes tratados com angioplastia. Os stents coronários foram capazes de reduzir as complicações imediatas e a reestenose coronária pós-angioplastia convencional. Analisamos os dois estudos já publicados, ARTS e ERACI II, comparando-se novamente as duas opções de tratamento. Os stents coronários otimizaram os resultados da angioplastia e reduziram a necessidade de reintervenção nos pacientes tratados percutaneamente. É possível que, no futuro, stents liberadores de drogas, tais como sirolimus e taxol,possam ser utilizados no tratamento desses pacientes, reduzindo ou mesmo abolindo as reintervenções pós-angioplastia...
We reviewed the results of 7 randomized trials, comparing percutaneous transluminal coronary angioplasty vs. coronary artery bypass grafting in the treatment of patients with multivessel coronary heart disease. The results showed no differences in the late mortality, but with more reinterventions in patients treated by percutaneous transluminal coronary angioplasty. The utilization of the coronary stents reduced the acute complications and the restenosis of percutaneous transluminal coronary angioplasty. In the analysis of the two published ARTS and ERACI II trials, we found an important reduction in the need of reinterventions in patients with multivessel disease. In the future the utilization of drug eluting stent with sirolimus or taxol can improve the results of percutaneous transluminal coronary angioplasty and reduce or abolish the need of reinterventions