Angioplastía en infarto agudo de miocardio: resultado inicial y seguimiento alejado / Angioplasty in acute myocardial infarction: early and late results

Background: The usefulness of angioplasty in the first hours of an acute myocardial infarction is widely demonstrated. However, its long term effects are less well known. Aim: To report the effects of coronary angioplasty on early and late outcome of patients with acute myocardial infarction. Patients and methods: A non-randomized, consecutive and retrospective analysis of the hospital and late outcome of 70 patients, aged 35 to 85 years, subjected to coronary angioplasty during an acute myocardial infarction. Patients were followed during 12 to 60 months. Results: Angioplasty was performed 5.3 ñ 5 hours after the initial symptoms. Anterior descendent artery was occluded in 63 percent of patients with a 99.5 percent luminal occlusion and TIMI 0-1 anterograde flow. An angiographic success was achieved in 83 percent of procedures with a residual stenosis of 32.3 percent. Recurrent ischemia was observed in 6 percent of patients, that were treated with a new revascularization procedure. Thirteen percent of patients died, all due to cardiogenic shock. Severe ventricular failure and failure of revascularization influenced mortality. During the first year of follow up there was a 3.3 percent mortality and 3.3 percent of patients required a new revascularization procedure. Eighty percent of patients were asymptomatic and event-free. Conclusion: Angioplasty was a useful therapeutic procedure in this group of patients

Implante de prótesis endovasculares (stents) en el tratamiento de la cardiopatía coronaria: resultados angiográficos, clínicos inmediatos y tardíos / Endovascular stent placing in the treatment of coronary artery disease: angiographic, immediate and late clinical results

Background: Coronary revascularization allows a better survival and quality of life in high risk patients with coronary artery disease. Aim: To report the experience in stent placement as treatment for obstructive atherosclerotic coronary artery disease. Patients and methods: A prospective analysis of 105 stent placements. A morphological and quantitative analysis of coronary angiograms, using an electronic caliper, was performed. Patients were followed during their hospital stay and after discharge. Results: In four of 112 coronary lesions, it was not possible to liberate the stent and in 108, it was successfully placed (48 in anterior descending, 19 in circumflex, 36 in right coronary arteries and 5 in saphenous aortocoronary by-pass. Lesions with stent implantation were type A in 11 percent, B1 in 30 percent, B2 in 44 percent and C in 15 percent. Reference diameter was 3.13 ñ 0.58 mm. After placement, luminal diameter increased from 0 95 ñ 0.43 to 2.99 ñ 0.46 mm, with a final stenosis of 7.2 ñ 10.1 percent. Angiographic success was obtained in 99 percent and procedure success in 98 percent. Hospital mortality was 0.98 percent. After a mean of eight months follow up, 91 percent of patients is free of major cardiac events. In 17 percent angina recurred and 5 percent required a new revascularization. There were no late cardiac deaths, acute stent thrombosis or infarction in relation to the treated lesion. Conclusions: In these patients, stent placement has had excellent immediate and late results