ABSTRACT
Introducción y objetivos: Comparar la estrategia de revascularización percutánea de lesiones graves en ramas coronarias secundarias (RS) (diámetro ≥ 2 mm) de arterias epicárdicas mayores frente al tratamiento conservador. Métodos: Estudio de cohortes retrospectivo en el que se compara a pacientes con lesiones graves en RS de arterias epicárdicas principales tratados con revascularización percutánea o con un tratamiento farmacológico a criterio del operador. Se analizó el porcentaje de eventos relacionados con la rama (muerte cardiovascular, infarto de miocardio atribuible a RS o necesidad de revascularización de la RS). Resultados: Se analizaron 679 lesiones en RS (662 pacientes). Tras un seguimiento medio de 22,2+/-10,5 meses, no hubo diferencias significativas entre ambos grupos de tratamiento en mortalidad de causa cardiovascular (el 1,7 frente al 0,4%; p=0,14), infarto agudo de miocardio (IAM) no fatal (el 1,7 frente al 1,7%; p=0,96) o necesidad de revascularización de la RS (el 4,1 frente al 5,4%; p=0,45) ni en el porcentaje total de eventos (el 5,1 frente al 6,3%; p=0,54). Las variables que mostraron asociación con la ocurrencia de eventos en el análisis multivariable fueron la diabetes (sHR=2,87; IC95%, 1,37-5,47; p=0,004), IAM previo (sHR=3,54; IC95%, 1,77-7,30; p < 0,0001), el diámetro de referencia de la RS (sHR=0,16; IC95%, 0,03-0,97; p=0,047) y la longitud de la lesión (sHR=3,77; IC95%, 1,03-1,13; p < 0,0001). Estos resultados se mantuvieron tras realizar análisis por puntuación de propensión. Conclusiones: En el seguimiento, el porcentaje de eventos relacionados con la RS fue bajo respecto al total de pacientes, sin diferencias significativas entre una y otra estrategia de tratamiento. Las variables que se asociaron con la ocurrencia de eventos en el análisis multivariable fueron la diabetes mellitus, el antecedente de IAM y la mayor longitud de la lesión
Introduction and objectives: To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter ≥ 2mm) of major epicardial arteries compared with conservative treatment. Methods: This study analyzed patients with severe SB lesions who underwent percutaneous revascularization treatment compared with patients who received pharmacological treatment. The study examined the percentage of branch-related events (cardiovascular death, myocardial infarction attributable to SB, or the need for revascularization of the SB). Results: We analyzed 679 SB lesions (662 patients). After a mean follow-up of 22.2+/-10.5 months, there were no significant differences between the 2 treatment groups regarding the percentage of death from cardiovascular causes (1.7% vs 0.4%; P=.14), nonfatal acute myocardial infarction (AMI) (1.7% vs 1.7%; P=.96), the need for SB revascularization (4.1% vs 5.4%; P=.45) or in the total percentage of events (5.1% vs 6.3%; P=.54). The variables showing an association with event occurrence on multivariate analysis were diabetes (SHR, 2.87; 95%CI, 1.37-5.47; P=.004), prior AMI (SHR, 3.54; 95%CI, 1.77-7.30; P<.0001), SB reference diameter (SHR, 0.16; 95%CI, 0.03-0.97; P=.047), and lesion length (SHR, 3.77; 95%CI, 1.03-1.13; P<.0001). These results remained the same after the propensity score analysis. Conclusions: The percentage of SB-related events during follow-up is low, with no significant differences between the 2 treatment strategies. The variables associated with event occurrence in the multivariate analysis were the presence of diabetes mellitus, prior AMI, and greater lesion length
Subject(s)
Humans , Percutaneous Coronary Intervention/methods , Coronary Occlusion/surgery , Acute Coronary Syndrome/surgery , Coronary Angiography/methods , Coronary Vessels/diagnostic imaging , Retrospective Studies , Angina, Stable/physiopathologyABSTRACT
INTRODUCTION AND OBJECTIVES: To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter ≥ 2mm) of major epicardial arteries compared with conservative treatment. METHODS: This study analyzed patients with severe SB lesions who underwent percutaneous revascularization treatment compared with patients who received pharmacological treatment. The study examined the percentage of branch-related events (cardiovascular death, myocardial infarction attributable to SB, or the need for revascularization of the SB). RESULTS: We analyzed 679 SB lesions (662 patients). After a mean follow-up of 22.2±10.5 months, there were no significant differences between the 2 treatment groups regarding the percentage of death from cardiovascular causes (1.7% vs 0.4%; P=.14), nonfatal acute myocardial infarction (AMI) (1.7% vs 1.7%; P=.96), the need for SB revascularization (4.1% vs 5.4%; P=.45) or in the total percentage of events (5.1% vs 6.3%; P=.54). The variables showing an association with event occurrence on multivariate analysis were diabetes (SHR, 2.87; 95%CI, 1.37-5.47; P=.004), prior AMI (SHR, 3.54; 95%CI, 1.77-7.30; P<.0001), SB reference diameter (SHR, 0.16; 95%CI, 0.03-0.97; P=.047), and lesion length (SHR, 3.77; 95%CI, 1.03-1.13; P<.0001). These results remained the same after the propensity score analysis. CONCLUSIONS: The percentage of SB-related events during follow-up is low, with no significant differences between the 2 treatment strategies. The variables associated with event occurrence in the multivariate analysis were the presence of diabetes mellitus, prior AMI, and greater lesion length.
Subject(s)
Coronary Stenosis/surgery , Coronary Vessels/surgery , Percutaneous Coronary Intervention/methods , Aged , Coronary Angiography , Coronary Stenosis/diagnosis , Coronary Vessels/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Propensity Score , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
BACKGROUND: Thrombolysis is still used when primary angioplasty is delayed for a long time, but 25%-30% of patients require rescue angioplasty (RA). There are no established recommendations for antithrombotic management in RA. This registry analyzes regimens for antithrombotic management. METHODS: A retrospective, multicenter, observational registry of consecutive patients treated with RA at 8 hospitals. All variables were collected and follow-up took place at 6 months. RESULTS: The study included 417 patients. Antithrombotic therapy in RA was: no additional drugs 22.3%, unfractionated heparin (UFH) 36.6%, abciximab 15.5%, abciximab plus UFH 10.5%, bivalirudin 5.7%, enoxaparin 4.3%, and others 4.7%. Outcomes at 6 months were: mortality 9.1%, infarction 3.3%, definite or probable stent thrombosis 4.3%, revascularization 1.9%, and stroke 0.5%. Mortality was related to cardiogenic shock, age > 75 years, and anterior location. The stent thrombosis rate was highest with bivalirudin (12.5% at 6 months). The incidence of bleeding at admission was high (14.8%), but most cases were not severe (82% BARC ≤2). Variables independently associated with bleeding were: femoral access (OR 3.30; 95% CI 1.3-8.3: p = 0.004) and post-RA abciximab infusion (OR 2.26; 95% CI 1.02-5: p = 0.04). CONCLUSIONS: Antithrombotic treatment regimens in RA vary greatly, predominant strategies consisting of no additional drugs or UFH 70 U/kg. No regimen proved predictive of mortality, but bivalirudin was related to more stent thrombosis. There was a high incidence of bleeding, associated with post-RA abciximab infusion and femoral access.
Subject(s)
Antibodies, Monoclonal/administration & dosage , Enoxaparin/administration & dosage , Fibrinolytic Agents/administration & dosage , Hirudins/administration & dosage , Immunoglobulin Fab Fragments/administration & dosage , Myocardial Infarction/therapy , Peptide Fragments/administration & dosage , Percutaneous Coronary Intervention , Thrombolytic Therapy , Abciximab , Aged , Antibodies, Monoclonal/adverse effects , Chi-Square Distribution , Coronary Thrombosis/etiology , Drug Administration Schedule , Enoxaparin/adverse effects , Female , Fibrinolytic Agents/adverse effects , Hemorrhage/chemically induced , Hirudins/adverse effects , Humans , Immunoglobulin Fab Fragments/adverse effects , Logistic Models , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Odds Ratio , Peptide Fragments/adverse effects , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Recombinant Proteins/administration & dosage , Recombinant Proteins/adverse effects , Registries , Retrospective Studies , Risk Factors , Spain , Thrombolytic Therapy/adverse effects , Thrombolytic Therapy/mortality , Time Factors , Treatment FailureSubject(s)
Angina, Unstable/therapy , Cardiovascular Agents/administration & dosage , Coronary Aneurysm/etiology , Coronary Thrombosis/etiology , Drug-Eluting Stents , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/instrumentation , Sirolimus/administration & dosage , Adult , Angina, Unstable/diagnostic imaging , Coronary Aneurysm/diagnostic imaging , Coronary Angiography , Coronary Thrombosis/diagnostic imaging , Humans , Male , Prosthesis Design , Time Factors , Tomography, Optical Coherence , Treatment OutcomeABSTRACT
Antagonists of the glycoprotein IIb/IIIa receptor block the binding of fibrinogen and Von Willebrand factor to the platelet receptor. This effect can lead to bleeding and thrombocytopenia. We analyzed the incidence and clinical repercussions of severe thrombocytopenia (< 20 000 /microl) secondary to abciximab treatment in a prospective study of 375 patients (74% men) who underwent percutaneous coronary revascularization and received abciximab at our hospital. We recorded clinical and demographic characteristics, angiographic findings, laboratory results and platelet counts (before, 4 hours after and 12 hours after the procedure) and hematocrit. The incidence of severe acute thrombocytopenia was 1.1%. All patients were men, and none had relevant bleeding complications. Management consisted of monitoring the bleeding, discontinuing the drug and transfusing platelets. Clinicians should be alert to this complication during the initial hours after the administration of abciximab.
