Angioplastia con stent vs. cirugía de revascularización coronaria en enfermedad multivaso (ACIRE) / Coronary angioplasty with stenting vs. coronary bypass revascularization surgery in multivessel disease

La enfermedad coronaria de múltiples vasos, es causa frecuente de procedimientos de revascularización percutánea o quirúrgica. La evolución de los pacientes sometidos a cualquier tipo de intervención, ha sido objeto de variados estudios clínicos aleatorizados y sus resultados han sido diversos a favor de uno u otro procedimiento. En este estudio prospectivo de cohorte, se analiza el desenlace clínico de 400 pacientes con enfermedad coronaria de dos o más vasos y se comparan resultados entre cirugía de revascularización y angioplastia con stent. Las poblaciones fueron comparables en sus características basales. Resultados: la tasa de mortalidad hospitalaria, al mes, seis y doce meses es similar en ambos procedimientos de revascularización. Sin embargo, la morbilidad intra-hospitalaria es mayor en el grupo de bypass con una tasa de infarto inmediato post-procedimiento mayor en dicho grupo cuando se compara con el percutáneo: 4,5% vs. 0% (p=0,005), una tasa de infecciones superior: 15,8% vs. 1,6% (p=0,001) y una estancia hospitalaria en unidad de cuidado intensivo más prolongada: 21,8% vs. 1,1% (p=0,001). La tasa de MACE (muerte, infarto, necesidad de revascularización del vaso previamente tratado) intra-hospitalaria asociada a la cirugía de revascularización, es significativamente mayor que la encontrada en el grupo de estrategia percutánea 8,4% vs. 1,6% (p=0,002) a expensas de una mayor tasa de infartos en el grupo quirúrgico. Los MACE a un mes y seis meses son similares en ambos grupos (tasa de 8,9% y 10,4% respectivamente para el grupo quirúrgico y del 5,7% y 15,5% para el grupo percutáneo) (p=NS). A 12 meses la tasa de MACE fue menor en el grupo quirúrgico (11,9%) cuando se comparó con el grupo percutáneo (19,2%) (p=0,045). Dicha diferencia se explica por una mayor necesidad de procedimientos de revascularización por falla del vaso tratado en el grupo de intervencionismo coronario percutáneo. Conclusiones: en la población evaluada, con enfermedad coronaria de dos o más vasos, la cirugía de revascularización ofrece un riesgo significativamente mayor de morbilidad intra-hospitalaria sin comprometer la mortalidad posterior hasta doce meses. En este grupo de pacientes, la angioplastia con stent ofrece mejor perfil de morbilidad post-procedimiento y mayor tasa de reintervención del vaso por falla a 12 meses de seguimiento. Tanto la cirugía como la angioplastia con stent, ofrecen tasas equivalentes de mortalidad hasta los doce meses de seguimiento.

Multivessel coronary heart disease is a common cause of revascularization procedures either surgical or by percutaneous intervention with angioplasty and stenting. Clinical outcomes of patients treated by any of these strategies have been addressed in different randomized clinical trials with diverse results favoring one or another procedure. This is a prospective cohort clinical trial aiming to analyze clinical outcomes of 400 patients with coronary heart disease involving two or more vessels comparing the outcomes between surgery and percutaneous intervention with coronary stenting. Baseline clinical characteristics were comparable between these groups. Results: in-hospital mortality rate at 1, 6 and 12 months is similar in both revascularization procedures. Nevertheless, in-hospital morbidity is significantly higher in the coronary artery bypass graft group with higher immediate post-procedural infarct-rate compared to that of the percutaneous coronary intervention (PCI) group (4,5% vs. 0%; p = 0,005), a higher infection rate (15,8% vs. 1,6%; p = 0,001) and an extended in-hospital stay in the intensive care unit (21.8% vs. 1,1%; p = 0,001). MACE in-hospital rate associated to revascularization surgery is signifficantly higher than that found in the percutaneous group (8,9% and 10,4% respectively for the surgical group and 5,7% and 15,5% for the percutaneous group; p = NS). MACE rate at 12 months was lower in the surgical group (11,9%) when compared to the percutaneous group (19,2%; p = 0,045). This difference can be explained by a furthermore need of revascularization due to failure in the target vessel in the percutaneous coronary intervention group. Target vessel (s) failure was 4% at 30 days (p = 0.059), 12% at 6 months (p = 0.001) and 18% at 12 months of follow-up (p < 0.0001) in the stenting group versus 0% at any time in the surgical group. There was no statistical difference in mortality at 12 months. Conclusions: in this cohort of patients with two or more vessel-coronary disease, surgical revascularization offers a statistically significant higher risk of in-hospital morbidity without compromising mortality up till 12 months after the procedure. Coronary stenting was found to offer a better post-procedural morbidity profile and higher risk of vessel reintervention at 6 and 12 months due to target vessel failure. Both coronary surgical revascularization and coronary stenting offer equivalent mortality rates and MACE incidence up to 1 year of follow-up.

Anesthesia for Aortocoronary Bypass Surgery - Six cases report / 대한마취과학회지

Six aortocoronary bypass surgeries were performed from May 1987 to September 1987 at Han Yang University Hospital utilizing the following anesthetic regimen. Preoperatively patients were given nitroglycerin, propranolol and nifedipine to maintain the hypodynamic state of the cardiovascular system. Anesthesia was induced and maintained with morphine, diazepam, and oxygen and supplemented with halothane with or without N2O. Nitroglycerin, sodium nitroprusside and dopamine were used to stabilize the hemodynamics during the intraoperative and postoperative periods, respectively. Six cases of aortocoronary bypass surgery were peformed safely without mortality.

Bio mechanical Properties of Coronary Aiteries in Human Ⅱ.The Stress-Strain Relationship under Biaxial Loading / 第三军医大学学报

For the first pt.see ibid vol.11 no.4,p.241 (1989).The anterior interven-tricular branch aad the circumflex branch of the left coronary artery,and the right coronary were excised from 7 autopsy adult subjects without heart diseases.A biaxial loading test for the vascular specimens was completed,which was simultaneously finished in the internal thoracic artery(ITA) and the great saphenous vein (GSV) of the same subjects in order to compare with the coronary arteries.Stress-strain relationships of the vessels were expressed by the exponential strain energy function.The meaning of the two-dimensional material constants for the vessels are discussed.

Biomechanical Properties of Coronary Arteries in Human.Ⅲ.Static Elastic Moduli,Microstructure and Clinical Significance / 第三军医大学学报

For the 1st and 2nd pts.see ibid vol.11,no.4t p.241 & p.251 (1989).The anterior interventricular branch and the circumflex branch of the left coronary artery and the right coronary artery were excised from 7 autopsy adult subjects without heart diseases.A biaxial loading test lor the vascular specimens was completed,which was simultaneously finished in the internal thoracic artery (ITA) and the great saphenous vein (GSV) of the same subjects in order to compare with the coronary arteries.Elastic moduli of the vessels increased with increasing pressure in the vessels.As compared with GSV the mechanical properties of ITA ap-proach the coronary arteries.It is assumed that the coronary artery bypass grafting choose ITA before GSV in view of the mechanical properties of the vascular walls.A ratio of collagen per elastin may be used as an index of the arterial elasticity.It is discussed that the biomechanical properties of the arteries may influence the pathogenesis of the arteriosclerosis.

Quantitative Analysis of Microstructural Components in Human Coronary Arteries / 第三军医大学学报

0.05). ITA contains elastin a relatively higher than the other two (P