[Comparative study of balloon dilatation and stent placement in primary angioplasty]. / Estudio comparativo entre uso de balón y empleo de stents de novo en la angioplastía primaria.

OBJECTIVE: To communicate our results with primary angioplasty (PA) and stenting de novo in acute myocardial infarction. MATERIAL AND METHODS: 163 patients (pts) had clinical diagnosis of MI with an average onset time of symptoms of 2.5 hours. They were divided in two groups: 100 pts with PA using only balloon (group I) and 63 pts with primary stenting (group II) (63 pts with 85 stents). A high pressure technique (14-16 atm) was used in group II and all pts were on salicylic acid and ticlopidine. Both groups were compared. RESULTS: Clinical characteristics, infarct location and infarct related-artery were similar, being left anterior descending the more frequently vessel involved. Clinical success rate was higher in group II (97% vs 87%) and complication rate was threefold higher in group I (9% vs 3%). A mean follow up of 57 months in group I showed a 21% clinical and/or angiographic restenosis rate, while the 12 months follow up in group II failed to show any case of restenosis at all. CONCLUSIONS: The use of stents in PA improves the results achieved with balloon procedures. There is a greater success rate, less complications and better survival patients who had the procedure while being in cardiogenic shock.

[Use of intracoronary stents without anticoagulants. Experience of the Hospital Espanõl of Mexico]. / Uso de stents intracoronarios sin anticoagulantes. Experiencia del Hospital Español de México.

Our initial experience with intracoronary stenting without oral anticoagulant is presented. From december 1994 to december 1995 we implanted 58 stents in 43 patients (36 males). Indications were: retraction 1, restenosis 3, dissection 8, acute myocardial infarction 13 and de novo 33. All patients received ticlopidin, aspirin and diltiazem before the procedure, heparin and intracoronary nitroglycerin were given during the procedure, and ticlopidin and aspirin for the next six weeks. Non-compliant balloons at 14-16 atmospheres were used for stent implantation. The balloon/artery ratio was 1:1. Implant sites were: 29 in left anterior descendent, 17 in right coronary artery, 7 in circumflex and 5 in vein grafts. This procedure was successful in 40/43 (93%) patients. One patient died and 2 had acute occlusion. One patient underwent coronary artery bypass grafting and the other underwent a new dilatation with higher pressure. There were no subacute occlusions. During 140 days mean time follow up: 2 patients had angina (incomplete revascularization) and 27 patients with negative stress test. No myocardial infractions or deaths were present during the follow up period. Stent implantation with high pressure technique and without oral anticoagulant in coronary arteries greater than 3.0 mm is a safe and effective method with high rate success and very low acute complication rate.

[The long-term follow-up of 400 coronary angioplasty patients]. / Seguimiento a largo plazo de 400 pacientes con angioplastía coronaria.

From October 1985 to May 1992, 400 patients had coronary angioplasty of 518 stenotic lesions with a 92% success rate. Mean stenosis was reduced from 88 to 15%. We had 25 major complications (6%): 8 emergency bypass surgery (2%), MI in 12 pts (3%) and 5 deaths (1%). Follow-up was possible in 329 of the 367 patients with a successful procedure (90%), with a mean follow-up of 44 months. We performed coronary angiogram in 113 patients with clinical data suggestive of restenosis, restenosis was found in 73, progression of the coronary atherosclerosis in 18 and 22 (19%) had no evidence of restenosis. A second coronary angioplasty was performed in 44 pts with a 93% success rate, 22 were sent to coronary bypass surgery and medical treatment was given to 7 patients. The 18 pts with progression of the disease were also sent to bypass surgery. During follow-up 25% of the patients required a second angioplasty or bypass surgery. A total of 115 (35%) pts showed evidence of restenosis: in 73 pts (22%) a coronary angiogram revealed restenosis, 12 had angina, 15 myocardial infarction and 15 died of cardiovascular disease. At the end of follow-up 259 pts (79%) were free of myocardial infarction, bypass surgery or cardiovascular death. Survival rate at 3.7 years was 94.5%. In conclusion, coronary angioplasty showed to be safe, effective and with a good long term outcome.

[Coronary angioplasty in 40 patients with 518 stenoses: complications and surgical support]. / Angioplastía coronaria en 400 pacientes con 518 estenosis: complicaciones y soporte quirúrgico.

We analyze the outcome of 400 patients (pts) with coronary angioplasty in 518 stenosis (314 men, age 29 to 80). The clinical syndromes were unstable angina in 252 pts, acute myocardial infarction (MI) in 26, angina or residual ischemia after thrombolysis for MI in 34 and 18 pts with post-MI angina. Success was achieved in 478 of 518 segments (92%). Mean stenosis was reduced from 88 to 15%. Revascularization was complete in 92% of pts. Primary success was 74% in total occlusions. We had 25 major complications (6%): 8 emergency bypass surgery (2%), MI in 12 pts (3%) and 5 deaths (1%). The procedures were performed without surgical standby in 220 pts: in 68 it was an emergency and in 152 it was considered a low risk procedure. Major complications in emergency cases were 3 MI (4%) and 2 deaths (3%). In the low risk procedures there were no deaths, 3 MI (2%) and 1 aortic dissection. We conclude that in well selected patients coronary angioplasty gives a high success rate with very few complications. Furthermore, it is possible to identify a very low risk subset of patients in whom the procedure can be performed without having a surgical standby.

[Use of 2-dimensional echocardiography in the diagnosis of interventricular septum rupture following myocardial infarction]. / Valor del ecocardiograma bidimensional en el diagnóstico de la ruptura del septum interventricular post-infarto del miocardio.

Interventricular septal rupture is a rare complication of the acute myocardial infarction. We report a case with rupture 4 weeks after diaphragmatic wall necrosis. The patient developed heart failure, precordial murmur and clinical signs of left-to-right shunt. The septal rupture was detected by two-dimensional echocardiogram and confirmed by catheterization. The surgical correction of the defect, was successful.

[Clinical significance of the muscular bands in the coronary arteries]. / Significado clínico de las bandas musculares en las arterias coronarias.

In 936 coronary angiocardiographies we found 46 patients with muscular bands. This report concerns 23 patients in which a muscular band was the only coronary pathological finding. In all cases the muscular band was located at the anterior descending artery. The angiocardiographic features that distinguishes the muscular epicardial bands are pointed out. The muscular bands can produce myocardial ischemic changes. Eighty-two per cent had ischemic changes in the resting EKG. Stress tests were positive only when the systolic obstruction was greater than 70%. The ischemic changes were observed in the myocardial zone irrigated by the narrowed artery and in 60% of the cases were accompanied by malfunction of the ventricular wall. In a follow up period averaging 28 months, the majority improved with beta-blockers. Two remained with angina.

[Correlation between findings of exertion ECG with 12 derivations and coronoriography]. / Correlación entre los hallazgos en el E.C.G. de esfuerzo con doce derivaciones y la coronariografía.

A coronary angiography was taken to 80 patients whose twelve leads exercise ECG had been found positive. This group included 38 patients with old myocardial infarction and 42 with coronary insuficiency. When looking for a relation between: 1. The amount of positivity in the exercise ECG and the number on injured vessels, and 2. the ischemia located in the effort test and the blocked vessels shown by the angiography. We found a reasonable relation between the exercise ECG and the severity of the injuries. This co-relation is of 100% between the old infarction area and the severe or total obstruction of the corresponding vessel. It was observed then, that a close relation exists between the ischemia area and the obstructive injuries. In a second group of 15 patients we failed to find atero sclerotic injuries in the corresponding vessel, but observed some vascular anomalies which explained the ischemia. The effort test with twelve leads exercise ECG makes easier the localization of obstructions, single or multiple, on the area supposedly affected.