Resultados clínicos de pacientes com reestenose intrastent não tratada com novo procedimento de revascularização / Clinical outcomes of patients with in-stent restenosis not treated with a revascularization procedure

RESUMO

INTRODUÇÃO: A reestenose clínica após o implante de stent coronário costuma ser tratada com revascularização da lesão-alvo (RLA). Nosso objetivo foi relatar o perfil clínico e os desfechos de pacientes com reestenose intrastent (RIS) sintomática que não foram submetidos a nova RLA. Métodos: Identificamos pacientes que presentaram reestenose clínica após colocação de stent coronário entre janeiro de 1997 e dezembro de 2001. As características clínicas e angiográficas e os desfechos clínicos dos pacientes que não passaram por nova revascularização (grupo sem RLA) foram comparados aos de pacientes revasclarizados (grupo com RLA). Todos os pacientes tiveram acompanhamento de pelo menos dois anos após implante do stent para ocorrência de eventos cardíacos adversos maiores (ECAM). Resultados:No período do estudo, 1.221 stents foram implantados em 1.149 pacientes. Observou-se RIS em 135 pacientes (12 por cento) dos quais 104 tiveram acompanhamento clínico e angiográfico completo, 23 no grupo sem RLA e 81 no grupo vom RLA. O período médio de acompanhamento após a colocação de stent coronário foi de 30,8 +- 7,5 meses. Pacientes do grupo sem RLA tiveram porcentual significativamente mais alto de doença...

ABSTRACT

BACKGROUND: Clinical restenosis after coronary stenting is generally treated by target vessel revascularization (TVR). This study was aimed at reporting the clinical profile and outcomes of patients with symptomatic in-stent restenosis (ISR) who were not submitted to a TVR. METHOD: Patients who presented clinical restenosis after coronary stenting between January 1997 and December 2001 were identified. Clinical and angiographic characteristics and clinical outcomes of patients who did not undergo a new revascularization (no-TVR group) were compared with revascularized patients (TVR group). All of the patients had at least 2 years of follow-up for the occurrence of major adverse cardiac events (MACE) after stent implantation. RESULTS: In the study period, 1,221 stents were implanted in 1,149 patients. ISR was observed in 135 patients (12%), of which 104 had complete clinical and angiographic follow-up, 23 in the no-TVR group and 81 in the TVR group. The mean follow-up period after coronary stenting was 30.8 ± 7.5 months. Patients in the no-TVR group had a significantly higher percent of one vessel disease (82% vs. 47%; P < 0.01). Patients in the no-TVR group had a long-term MACE rate of 21.7% (5 patients 2 deaths, 3 myocardial infarctions), whereas those submitted to a new revascularization showed a subsequent MACE rate of 9.8% (8 patients 1 death, 4 myocardial infarctions, 3 coronary artery bypass graft surgery; P = 0.11). CONCLUSION: Patients with clinical ISR not treated with a TVR more frequently presented one-vessel disease and a trend towards higher incidence of MACE when compared to those treated with a new TVR.