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2001, Número 1

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Arch Cardiol Mex 2001; 71 (1)


Seguimiento clínico y angiográfico en adultos jóvenes post ACTP más stents intracoronarios.

Palomo VJA, Reyes CFA, Plaza HA, Farell CJ, Abundes VA, Montoya GAS, Ledesma VM

Idioma: Español
Referencias bibliográficas: 54
Paginas: 34-41
Archivo PDF: 67.56 Kb.


RESUMEN

Revisamos nuestra experiencia y evaluamos los resultados clínicos y angiográficos así como el seguimiento de los pacientes adultos jóvenes ‹ 40 años que fueron sometidos a angioplastia coronaria, transluminal percutánea (ACTP) con prótesis endovasculares “stents”. Material y métodos: Entre enero de 1995 y diciembre de 1999, en que se realizaron 896 procedimientos de ACTP con colocación de stents a 770 enfermos. Se incluyó sólo un grupo selecto de 30 pacientes (con 32 procedimientos con un promedio de 1.06 stents por paciente) con edades de 21 a 39 años, promedio de 32.8 ± 5.2, de sexo masculino 29 (96.6%) y sólo una mujer (3.3%). Nueve enfermos (30%) estaban con angina severa clase III de Braunwald y 21 (70%) tenían antecedente de infarto del miocardio previo. El porcentaje promedio de obstrucción arterial 90.08 ± 5.22 y la fracción de expulsión (FE) promedio 46.8 ± 4.3 con rangos de 35 a 60%. Resultados: El éxito angiográfico inmediato fue de 93.75% sólo en dos enfermos 6.25% con oclusión del 100% y mayor a doce semanas se fracasó. No existió mortalidad, ni infarto y no se envió a ningún enfermo a cirugía urgente de revascularización. El seguimiento clínico fue de tres a 50 meses, en todos, con prueba de esfuerzo (PE) eléctrica tipo Bruce y/o de medicina nuclear. Sólo en tres enfermos se reportó PE y talio con isquemia septal leve. Control angiográfico en 27 (90%) entre el cuarto y sexto mes. Conclusiones: La ACTP con stent es un procedimiento exitoso angiográfico y clínico en adultos jóvenes ‹ 40 años, constituye una terapéutica de revascularización completa y eficaz, es una excelente opción antes de enviarlos a cirugía de revascularización aorto-coronaria.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Bergstrand R, Verdin A, Wilhemsson C, Wallin J, Wedel H, Wilheimsen L: Myocardial infarction among men below age 40. Br Heart J 1978; 40: 783-788.

  2. Weingerber I, Rotenberg Z, Fuchs J, Sagy A, Friedmann J, Agmon J: Myocardial infarction in young adults under 30 years: risk factor and clinical course. Clin Cardiol 1987; 10: 9-15.

  3. Roth D, Berki A, Wolff G: Long rang observations in fifty three young patients with myocardial infarction. Am J Cardiol 1967; 19: 331-338.

  4. Davia J, Hallal F, Cheitlin M, Gregoratos G, McCarty R, Foote W: Coronary artery disease in young patients, arteriographic and clinical review of 40 cases aged 35 and under. Am Heart J 1974; 87: 689-696.

  5. Lim J, Produfit W, Sones F: Selective coronary arteriography in young men. Circulation 1974; 59: 1122-1126.

  6. Lytle B, Kramer J, Golding L, Cosgrove D, Borsh J, Goormastic M, et al: Young adults with coronary atherosclerosis: 10 years results of surgical myocardial revascularization. J Am Coll Cardioll 1984; 4: 445-453.

  7. Fitzgibbon G, Hamilton M, Leach A, Kafka H, Markle H, Keon W: Coronary artery disease and coronary bypass grafting in young men: experience with 138 subjects 39 years of age and younger. J Am Coll Cardiol 1987; 9: 977-988.

  8. Kelly T, Craver J, Jones E, Hatcher C: Coronary revascularization in patients 40 years and younger: surgical experience and long-term follow-up. Am J Surg 1978; 44: 675-678.

  9. Roubin G, Cannon A, Agrawal S, Dean L, Baxley W, Brealand J: Intracoronary stening for acute and threatened closure complicating percutaneous transluminal coronary angioplasty. Circulation 1992; 85: 916-927.

  10. Ledesma M, Farell J, Astudillo R, Abundes A, Escudero X, Montoya S, et al: Stents intracoronarios: Experiencia en el Hospital de Cardiología del Centro Médico Nacional Siglo XXI. Arch Inst Cardiol Mex 1997; 67: 101-105.

  11. Villavicencio R, Marchena A, Eid G, Lechuga A, Peña M, Gaspar J, et al: Stent coronario en el infarto agudo del miocardio. Arch Inst Cardiol Mex 1998; 68: 18-26.

  12. Colombo A, Hall P, Nakamura S: Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation 1995; 91: 1676-1688.

  13. Mock M, Holmes D, Vliestra R, Gersh B, Detre K, Kesley et al: Percutaneous transluminal coronary angioplasty (PTCA) in the elderly patient: experience in the National Heart, Lung and Blood Institute PTCA Registry. Am J Cardiol 1984; 53: 89C-91C.

  14. Walker W, Gregoratos G: Myocardial infarction in young men. Am J Cardiol 1967; 19: 339-343.

  15. Gohke H, Sturzenhofecker P, Goranot L, Thilo A, Haakshorst W, Rosliamm H: Myocardial infartion at young age correlation of angiographic findings with risk factors and history of 619 patients. Circulation 1980; 62: (Suppl III): 39.

  16. Sheldon W, Razavi M, Lim Y: Coronary arteriographic findings in youngs survivors of acute myocardial infarction including those with normal coronary arteries. In: Myocardial infarction at young age. New York. Springer-Verlang, 1981: 47-77.

  17. Roberts W, Buja I: The frequency and significance of coronary arterial trombi and other observations in fatal acute myocardial infarction. A study of 107 necropsy patients. Am J Cardiol 1971; 52: 425-429.

  18. Simpfendorfer C, Tuzcu E, Badhwar K: Percutaneous transluminal coronary angioplasty in the young adult. Cleve Clin Med 1989; 56: 569-572.

  19. Stone G, Ligon R, Rutherford B, McConahay D, Hartzler G: Short-term outcome and long-term follow up following coronary angioplasty in the young patient: an 8 year experience. Am Heart J 1989; 118: 873-877.

  20. Webb J, Myler R, Shaw R, Anwar A, Stertzer S: Coronary angioplasty in young adults: Initial results and late outcome. J Am Coll Cardiol 1990; 16: 1569-1574.

  21. BARI Investigators: Comparison of coronary bypass with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI). N Engl J Med 1996; 335: 217-225.

  22. Underwood D, Proudfit W, Lim J, MacMillan J: Symptomatic coronary artery disease in patients aged 21 to 30 years. Am J Cardiol 1985; 55: 631-634.

  23. Myler R, Topol E, Shaw R: Multiple vessel coronary angioplasty: classification, results and patterns of restenosis in 494 consecutive patients. Cathet Cardiovasc Diagn 1987; 13: 1-15.

  24. Myler R, Stertzer S, Cumberland D, Shaw R: Multiple vessel angioplasty. J Invest Cardiol 1989; 1: 191-197.

  25. Fishman D, Leon M, Baim D: A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994; 331: 496-501.

  26. Serruys P, Jaegere P, Kiemeneij F: A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994; 331: 489-495

  27. Rodriguez A, Santaera O, Larribau M: Coronary stenting decreses restenosis in lesions with early loss in luminal diameter 24 hours after successful PTCA. Circulation 1995; 91: 1397-1402.

  28. Erbel R, Haude M, Hoepp H: Restenosis stent (REST) study: randomized trial comparing stenting and balloon angioplasty for treatment of restenosis after balloon angioplasty. J Am Coll Cardiol 1996; (Suppl A): 139-A.

  29. Lim J, Proudrit W, Sones F: Selective coronary arteriography in young men: a follow up of 449. Circulation 1974; 49: 1122-1126.

  30. Lamm G: The epidemiology of acute myocardial infarction in young age groups: In myocardial infarction at young age. Roskamm H Ed. New York. Springer-Verlag, 1981: 1-55.

  31. Gertler M, White P, Simon R, Gottsch L: Long-term follow-up of young coronary patients. Am J Med Sci 1964; 246: 145-154.

  32. Antiplatelet Trialist’ Collaboration. Collaborative overview of randomized trials of antiplatelet therapy. Prevention od death, myocardial infarction and stroke by prolonged antiplatelet therapy in various categories of patients. Br J Med 1994; 308: 81-106.

  33. Yusuf S, Peto R, Lewis J, Collins R, Sleight P: Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985; 27: 335-371.

  34. Pfeffer E, Braunwald E, Moye L, Basta L, Brown E, Cuddy T, et al: Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 1992; 327: 669-677.

  35. Scandinavian Simvastatin Survival Study Group: Randomized trial of cholesterol lowering in 4,444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383-1389.

  36. Kelly M, De Laria G, Najafi H: Coronary artery bypass surgery in patients less than 40 years of age. Chest 1988; 94: 1138-1141.

  37. Jones J, Ochsner J, Mills N, Hugs L: Long term results of myocardial revascularization in early-onset arteriosclerosis. Surgery 1980; 88: 760-765.

  38. Cohen D, Basamania C, Graeber G, Desbong J, Burge J: Coronary artery bypass grafting in young patients under 36 years of age. Chest 1986; 89: 811-816.

  39. Cosgrove D, Loop F, Lytie B: Predictors of reoperation after myocardial revascularization. J Thorac Cardiovasc Surg 1986; 92: 811-821.

  40. Foster E, Fisher L, Kaiser G, Niyers W: Comparison of operative mortality and morbidity for initial and repeat coronary artery bypass grafting: the Coronary Artery Surgery Study (CASS) Registry experience. Ann Thorac Surg 1984; 38: 563-570.

  41. Campeau L, Enjalbert M, Lesperance J: Atherosclerosis and late closure of aortocoronary saphenous vein grafts: sequential angiographic studies at 2 weeks, 1 year, 5 to 7 years and 10 to 12 years after surgery. Circulation 1983; 62: (Suppl II) 1-4.

  42. Grondin C, Campeau L, Lesperance J, Enjalbert T, Bourassa M: Comparison of late changes in internal mammary artery and saphenous vein grafts in two consecutive series of patients ten years after operation. Circulation 1984; 70:(1) 1-208.

  43. Loop F, Lytle B, Cosgrove D: Influence of the internal mammary artery graft on 10 years survival and ither cardiacs events. N Engl J Med 1986; 314: 1-5.

  44. French J, Scott D, Whitlock R, Nisbet H, Vedder M, Kerr A: Late outcome after coronary bypass graft surgery in patients < 40 years old. Circulation 1995; 92: (Suppl II): 14-19.

  45. Ellis C, French J, White H, Ormiston J, Whitlock R, Webster M: Results of percutaneous coronary angioplasty in patients < 40 years of age. Am J Cardiol 1998; 82: 135-139.

  46. Weintraub W, Mauldin P, Becker E, Kosinski A, King S: A comparison of the costs of and quality of life after coronary angioplasty or coronary surgery for multivessel coronary artery disease. Circulation 1995; 92: 2831-2840.

  47. Plante S, Strauss B, Goulet G, Watson R, Chisholm R: Reuse of balloon catheters for coronary angioplasty: a potencial cost-saving strategy? J Am Coll Cardiol 1994; 15: 1475-1481.

  48. Ellis S, Miller D, Brown K, Omoigui N, Howeil G, Topol E: In-hospital cost of percutaneous coronary revascularization. Critical determinants and implications. Circulation 1995; 92: 741-747.

  49. Zhao X, Brown B, Stewart D, Hillger L, Barnhart H, Koisinki A, et al: Effectiveness of revascularization in the Emory angioplasty versus surgery trial. A randomized comparison of coronary angioplasty with bypass surgery. Circulation 1996; 93: 1954-1962

  50. Shook T, Sun G, Burstein S, Eisenhauer A, Matthews R: Comparison of percutaneous transluminal coronary angioplasty outcome and hospitals costs for low-volume and high volume operators. Am J Cardiol 1996; 77: 331-336.

  51. Hlatky M. Analysis of costs associated with CABG and PTCA. Ann Thorac Surg 1996; 61: (2 Suppl); S30-S34.

  52. Herlitz J, Albertsson P, Haglid M, Karison B, Hartford M, Sanden W: The cost-benefit balance of coronary artery bypass grafting: need for hospitalization during the two years before and the two years after. Thorac Cardiovasc Surg 1996; 44: 239-244.

  53. Heidenreich P, Chou T, Amidon T, Ports T, Browner W: Impact of the opertating physician on costs of percutaneous transluminal coronary angioplasty. Am J Cardiol 1996; 77: 1169-1173.

  54. Weintraub W, Jones E, Morris D, King S, Guyton R, Craver J: Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery. Circulation 1997; 95: 868-877.




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