[Stent thrombosis in the modern era: incidence, outcome and predictive factors]. / Trombosis del stent en la era moderna: incidencia, consecuencias y factores predictores.

Coronary stent thrombosis is a catastrophic complication of percutaneous coronary intervention. Its incidence is reported to be about 1%, though it can occur more frequently in high-risk patients, in high-risk lesions, and in multivessel procedures. We investigated the occurrence of stent thrombosis in 404 consecutive patients in a period when conventional and drug-eluting stents were both being used. We found an overall incidence of 2.23%, a mortality rate of 22.2%, and a non-fatal myocardial infarction rate of 66.6%. Predictors of stent thrombosis were acute myocardial infarction, multiple stent placement, poor ejection fraction, small stent diameter, the presence of residual dissection, and premature discontinuation of clopidogrel.

Trombosis del stent en la era moderna: incidencia, consecuencias y factores predictores / Stent Thrombosis in the Modern Era: Incidence, Outcome and Predictive Factors

La trombosis del stent (TS) es una complicación temida del intervencionismo coronario percutáneo por sus consecuencias catastróficas, cuya incidencia aproximada es del 1% y que puede ser más frecuente en procedimientos realizados en pacientes/lesiones de alto riesgo o procedimientos multivaso. Analizamos la aparición de TS en una población de 404 pacientes consecutivos en un período en el que se utilizaron tanto stents recubiertos como stents convencionales, con una incidencia global del 2,23%, una mortalidad del 22,2% y una tasa de infarto agudo de miocardio no fatal del 66,6%. Los factores predictores de aparición de TS fueron: indicación por infarto agudo de miocardio, implante de múltiples stents, peor fracción de eyección, diámetro de stent más pequeño, presencia de disección residual y abandono precoz de clopidogrel (AU)

Coronary stent thrombosis is a catastrophic complication of percutaneous coronary intervention. Its incidence is reported to be about 1%, though it can occur more frequently in high-risk patients, in high-risk lesions, and in multivessel procedures. We investigated the occurrence of stent thrombosis in 404 consecutive patients in a period when conventional and drug-eluting stents were both being used. We found an overall incidence of 2.23%, a mortality rate of 22.2%, and a non- fatal myocardial infarction rate of 66.6%. Predictors of stent thrombosis were acute myocardial infarction, multiple stent placement, poor ejection fraction, small stent diameter, the presence of residual dissection, and premature discontinuation of clopidogrel (AU)

[Anomalous left coronary artery from the right sinus of Valsalva associated with coronary atheromatosis]. / Arteria coronaria izquierda anómala en el seno de Valsalva derecho asociada a ateromatosis coronaria.

Anomalous origin of the left coronary artery from the right sinus of Valsalva is an anatomical abnormality that is usually associated with myocardial ischemia and sudden death. Although this abnormality may coexist with obstructive atherosclerotic coronary disease, disease is not usually found in the anomalous course of the artery. When this coronary anomaly and obstructive coronary disease are both present, it is difficult to determine the cause of ischemic symptoms. We report a case in which three different diagnostic techniques were used to find the cause of ischemic symptoms in a patient whose left coronary artery originated anomalously in the right sinus of Valsalva and followed a course between the aorta and the pulmonary trunk and who had obstructive atherosclerotic lesions in the right coronary artery. The techniques were conventional angiography, which was used for the initial diagnosis, multislice computerized tomography, which was used to determine the anomalous course of the artery and its relationship with vascular structures, and exercise echocardiography, which was used to evaluate ischemia in the left coronary artery territory after treatment of the stenoses in the right coronary artery.

Arteria coronaria izquierda anómala en el seno de Valsalva derecho asociada a ateromatosis coronaria / Anomalous left coronary artery from the right sinus of Valsalva associated with coronary atheromatosis

El origen anómalo de la arteria coronaria izquierda en el seno de Valsalva derecho es una anomalía que suele asociarse con isquemia miocárdica y muerte súbita. Aunque puede coexistir con aterosclerosis coronaria, ésta no suele asentar en el trayecto coronario anómalo. Cuando coexiste esta anomalía coronaria con la enfermedad aterosclerótica coronaria resulta difícil diferenciar el origen de los síntomas isquémicos. Presentamos un caso en el que se emplearon 3 modalidades diagnósticas para dilucidar el origen de los síntomas isquémicos en un paciente con origen anómalo de la coronaria izquierda en el seno de Valsava derecho y trayecto entre la aorta y el tronco pulmonar asociado con lesiones ateroscleróticas obstructivas en la coronaria derecha: la angiografía convencional como diagnóstico inicial, la tomografía computarizada para identificar con exactitud el trayecto de la coronaria anómala y su relación con estructuras vasculares y la ecocardiografía de esfuerzo para valorar isquemia en territorio de la coronaria izquierda tras el tratamiento de las lesiones en la coronaria derecha

Anomalous origin of the left coronary artery from the right sinus of Valsalva is an anatomical abnormality that is usually associated with myocardial ischemia and sudden death. Although this abnormality may coexist with obstructive atherosclerotic coronary disease, disease is not usually found in the anomalous course of the artery. When this coronary anomaly and obstructive coronary disease are both present, it is difficult to determine the cause of ischemic symptoms. We report a case in which three different diagnostic techniques were used to find the cause of ischemic symptoms in a patient whose left coronary artery originated anomalously in the right sinus of Valsalva and followed a course between the aorta and the pulmonary trunk and who had obstructive atherosclerotic lesions in the right coronary artery. The techniques were conventional angiography, which was used for the initial diagnosis, multislice computerized tomography, which was used to determine the anomalous course of the artery and its relationship with vascular structures, and exercise echocardiography, which was used to evaluate ischemia in the left coronary artery territory after treatment of the stenoses in the right coronary artery